FHR vs. PFNA for femoral neck basicervical fractures in elderly patients 60 years or older: a cost-effectiveness analysis from hospitals in western China under the background of medical insurance

TL;DR

This study compares the cost-effectiveness of two surgical treatments for hip fractures in elderly patients in western China, finding that one is more cost-effective while the other allows faster recovery.

Contribution

The study provides a cost-effectiveness analysis of PFNA and FHR for femoral neck basicervical fractures in elderly patients in western China.

Findings

PFNA is more cost-effective than FHR for treating femoral neck basicervical fractures in elderly patients.

FHR allows for faster early functional recovery but requires significantly higher costs per QALY.

Surgical decisions should consider patient-specific priorities, such as cost or early recovery.

Abstract

Femoral neck basicervical fractures are an unstable subtype with high surgical failure risk. This study compares the cost-effectiveness of PFNA and FHR in elderly patients (60 years or older) to guide rational treatment amid aging and limited medical resources.

A retrospective study included 76 patients (May 2022–May 2025) who underwent PFNA or FHR. 1:1 PSM balanced baseline characteristics (age, gender, pre-injury FRS, Garden classification, comminution, bone quality, AO/OTA subtype). Total hospital costs were collected to calculate CER and QALY-based ICER. FRS and EQ-5D-5L scales evaluated function and QALYs, with sensitivity analyses verifying robustness.

After PSM, 28 matched pairs were analyzed. PFNA had a lower CER (751.74 vs. 874.60 yuan/point, p = 0.002) and QALY-based CER (72,875.25 vs. 82,761.68 yuan/QALY). FHR required an additional 328,318.00 yuan/QALY (95% CI: 286,542.30–370,093.70), exceeding China's WTP threshold (85,698–257,094 yuan/QALY) but acceptable for specific subgroups. Both achieved favorable outcomes; FHR had faster early functional recovery.

For elderly adults 60 years or older with femoral neck basicervical fractures, both PFNA and FHR can achieve favorable clinical outcomes. PFNA is more cost-effective overall, while FHR offers faster early functional recovery. Surgical decision-making should balance these factors, along with patient-specific characteristics. For patients prioritizing early independent ambulation and reducing caregiver burden, FHR is a suitable choice; for those focusing on cost-effectiveness and long-term functional recovery, PFNA is preferred. Future prospective multicenter studies with longer follow-up (5 years or longer) are needed to evaluate long-term revision costs and further validate these findings, while accounting for indirect costs and minimizing selection bias.