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Calculating and comparing value in orthopaedic hip trauma: A systematic review
Lindsay Maier1, Zachary Chen1,2, Mithil Gudi1,2
1Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI, 48202, USA.
Objectives:
To evaluate the existing literature on value comparisons between treatment strategies in orthopaedic hip fracture care using real-world clinical data and standardized cost-effectiveness metrics.Materials and Methods.
Data Sources:
A comprehensive search of PubMed, Embase, and Web of Science was conducted for studies published between January 1, 2003, and May 30, 2024. Only English-language articles were included.
Study Selection:
Eligible studies directly compared two or more treatment strategies for hip fracture care and included a value-based economic evaluation using clinical (non-simulated) data. Exclusion criteria included simulation models, protocols, case reports, systematic reviews, and meta-analyses.
Data Extraction:
Two independent reviewers screened titles, abstracts, and full texts using PRISMA guidelines. Discrepancies were resolved by a third reviewer. Extracted variables included study design, intervention type, cost perspective, quality metric used, and economic evaluation method.
Data Synthesis:
Studies were analyzed descriptively. Outcome measures included cost-effectiveness ratios such as ICER, ICUR, and NMB. QALYs were used to enable cross-study comparisons.
Results:
Sixteen of 935 screened full-text articles met inclusion criteria. Most studies evaluated surgical interventions. Cemented hemiarthroplasty showed a favorable NMB compared to uncemented implants. Liposomal bupivacaine and tranexamic acid were cost-effective due to lower operating costs and shorter hospital stays. Internal fixation was more cost-effective than hemiarthroplasty in some settings despite lower quality outcomes. Operative treatment in frail, institutionalized patients offered minimal QALY benefit at high cost. Home-based post-acute care and fracture liaison services improved value, while outreach rehab lacked long-term cost-effectiveness. Most studies used public payer perspectives and EQ-5D-derived QALYs.
Conclusion:
There is significant variability in how value is calculated and reported in hip fracture care. Standardized value frameworks using a hospital/clinic perspective, patient-reported outcomes transformed into QALYs, and cost-utility ratios compared with the ICER equation should be utilized in future studies.
Level Of Evidence:
Level III (Systematic Review of Comparative Studies).
