Cost-effectiveness analysis of surgical proximal femur fracture prevention in elderly: a Markov cohort simulation model

Cost Effectiveness and Resource Allocation

Research

Momin S. Alnemer¹  Konstantin E. Kotliar¹  Bernhard D. Ciritsis²  Hans-Christoph Pape³  Valentin Neuhaus³ 

[1] Department of Medical Engineering and Technomathematics, Aachen University of Applied Sciences, Campus Juelich, Heinrich-Mussmann-Str. 1, 52428, Juelich, Germany;Orthopaedic Surgery Unit, Centro Ortopedico di Quadrante, Lungolago Buozzi, 25, 28887, Omegna, VB, Italy;Trauma Surgery Unit, Universitätsspital Zürich, Rämistrasse 100, 8091, Zürich, Switzerland;

关键词: Hip fractures;    Prevention;    Geriatric;    Cost-effectiveness;    Prophylaxis;    Healthcare utilization;    Quality-adjusted life-year;    Finite-State Markov Model;    Sensitivity analysis;    Surgical Prophylaxis;   

DOI  :  10.1186/s12962-023-00482-4

 received in 2022-12-23, accepted in 2023-09-20,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundHip fractures are a common and costly health problem, resulting in significant morbidity and mortality, as well as high costs for healthcare systems, especially for the elderly. Implementing surgical preventive strategies has the potential to improve the quality of life and reduce the burden on healthcare resources, particularly in the long term. However, there are currently limited guidelines for standardizing hip fracture prophylaxis practices.MethodsThis study used a cost-effectiveness analysis with a finite-state Markov model and cohort simulation to evaluate the primary and secondary surgical prevention of hip fractures in the elderly. Patients aged 60 to 90 years were simulated in two different models (A and B) to assess prevention at different levels. Model A assumed prophylaxis was performed during the fracture operation on the contralateral side, while Model B included individuals with high fracture risk factors. Costs were obtained from the Centers for Medicare & Medicaid Services, and transition probabilities and health state utilities were derived from available literature. The baseline assumption was a 10% reduction in fracture risk after prophylaxis. A sensitivity analysis was also conducted to assess the reliability and variability of the results.ResultsWith a 10% fracture risk reduction, model A costs between $8,850 and $46,940 per quality-adjusted life-year ($/QALY). Additionally, it proved most cost-effective in the age range between 61 and 81 years. The sensitivity analysis established that a reduction of ≥ 2.8% is needed for prophylaxis to be definitely cost-effective. The cost-effectiveness at the secondary prevention level was most sensitive to the cost of the contralateral side’s prophylaxis, the patient’s age, and fracture treatment cost. For high-risk patients with no fracture history, the cost-effectiveness of a preventive strategy depends on their risk profile. In the baseline analysis, the incremental cost-effectiveness ratio at the primary prevention level varied between $11,000/QALY and $74,000/QALY, which is below the defined willingness to pay threshold.ConclusionDue to the high cost of hip fracture treatment and its increased morbidity, surgical prophylaxis strategies have demonstrated that they can significantly relieve the healthcare system. Various key assumptions facilitated the modeling, allowing for adequate room for uncertainty. Further research is needed to evaluate health-state-associated risks.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

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