Internal fixation versus hemiarthroplasty for displaced femoral neck fractures in the elderly: A cost-effectiveness analysis

•An advantage of this study is the use of the cost diary, which facilitated complete and detailed data collection. We asked the patients to record all the costs so that the accuracy of this study could be ensured.•Many studies related to the costs of fracture only collected the medical costs. We used cost diary to record medical and non-medical costs which increase the integrity of cost data.•Another advantage is the application of advanced statistical methods which increase the reliability of the data.•Most researches on cost-effectiveness analysis (CEA) were conducted in western countries. Similar research has rarely been reported in China. Our study enriches the knowledge base of the research field of CEA of displaced femoral neck fractures and indicates that the final results may be not consistent across different countries. There is little information on the cost and outcome of different treatments for femoral neck fractures. This study aimed to evaluate the cost-effectiveness of internal fixation compared with hemiarthroplasty (HA) for elderly patients with displaced femoral neck fractures. A total of 121 patients ≥ 65 years old were divided into internal fixation (n = 58) or HA group (n = 63). Clinical outcome was evaluated by the EuroQol 5 dimensions (EQ-5D) score at 3, 12, and 24 months. The total costs including medical and non-medical expense were collected through hospitalisation information, cost diaries, and telephone interviews. A cost-utility analysis of the total costs in combination with quality-adjusted life years (QALYs) calculated by EQ-5D and survival time was conducted. Results were expressed in incremental cost-effectiveness ratio (ICER). The mean EQ-5D index score in the HA group were higher at the early follow-up (p0.05). Over the 2-year period, patients treated with HA gained 0.09–0.10 more QALYs than those treated with internal fixation, while the mean total costs for internal fixation (CNY 55,676) were significantly lower than for HA (CNY 80,297) (P