Cost-saving analysis of ultrasound-guided regional anesthesia for hip fractures: A probabilistic cost-utility...

Despite evidence that regional anesthesia (RA) improves outcomes in older adults with hip fracture, adoption remains variable, and cost-effectiveness in U.S. settings is unknown. This study evaluated the cost-effectiveness of RA versus usual care using a probabilistic Monte Carlo cost-utility model.

A 10,000-iteration probabilistic Monte Carlo cost-utility model compared RA plus usual care to usual care alone for U.S. adults aged ≥65 years with hip fracture over a 90-day hospital perspective. Inputs were derived from clinical trials, systematic reviews, and U.S. cost data. Primary outcomes were total costs and quality-adjusted life-years (QALYs); secondary outcomes included delirium rates, length of stay, opioid use, and discharge disposition. Cost-effectiveness was assessed at a $120,000/QALY threshold per 2025 AHA/ACC recommendations.

RA dominated usual care, yielding mean cost savings of $7826 per patient (95% credible interval [CrI]: 3490 to 13,311) and a QALY gain of 0.0028 (95% CrI: 0.000687 to 0.005751). Savings were driven by shorter hospitalization (5.97 vs. 6.96 days), lower probability of skilled nursing facility discharge (55.4% vs. 60.0%), and fewer facility days among those discharged (19.9 vs. 23.9 days). Delirium-related costs contributed additional savings, reflecting lower delirium incidence (25.2% vs. 35.0%; RR 0.72). The probability of cost-effectiveness was near 100.0% at $120,000/QALY. Extrapolated to the reported 52.9% national adoption rate (∼158,700 patients annually), estimated U.S. savings are $1.24 billion with 449 QALYs gained. Results were robust across all sensitivity analyses.

RA for older adults with hip fracture was cost-saving and improved quality-adjusted outcomes. These findings provide an economic rationale for incorporating regional anesthesia into standard hip fracture care pathways in U.S.