Is prophylactic fixation a cost-effective method to prevent a future contralateral fragility hip fracture?

Area of Science:

• Orthopedic surgery
• Health economics
• Geriatric medicine

Background:

• Previous hip fracture significantly increases the risk of a contralateral hip fracture.
• Low compliance rates are observed with current pharmacologic and environmental hip fracture prevention strategies.

Purpose of the Study:

• To evaluate the cost-effectiveness of prophylactic fixation of the uninjured hip to prevent contralateral hip fracture.

Main Methods:

• A Markov state-transition model was employed to assess costs and quality-adjusted life-years (QALYs).
• The model compared unilateral hip fracture fixation alone versus unilateral fixation with contralateral prophylactic fixation or hip pads.
• Sensitivity analyses explored the impact of various patient and intervention factors on cost-effectiveness.

Main Results:

• Prophylactic fixation was not cost-effective for the average 79-year-old woman (ICER = $142,795/QALY).
• Cost-effectiveness was observed in women aged 71-75 with a 30% higher contralateral fracture risk and in women younger than 70.
• The cost-effectiveness was sensitive to the additional cost of prophylaxis (ideally <$6000) and the effectiveness of the procedure.

Conclusions:

• Prophylactic cephalomedullary nailing is not cost-effective for the general population of older women post-hip fracture.
• This intervention may be suitable for specific patient groups with elevated lifetime risk for contralateral fractures.
• Further research, including basic science and clinical trials, is needed to determine effectiveness in high-risk populations.