Comparing total medical costs of surgical treatment versus nonoperative care for femoral neck fractures among Alzheimer's disease patients: A retrospective cohort study

•The treatment decision to address femoral neck fractures in older adults with Alzheimer's disease depends on patients’ specific clinical circumstances, which impacts the quality and costs of care.•The surgical treatment approach for femoral neck fracture is more costly but also yields better clinical outcomes compared to non-operative care.•Surgical treatment cohorts not only involved direct medical costs associated with surgery but also incurred high post-surgery rehabilitation costs in nursing homes or home health settings.•Comorbidities such as history of falls, sarcopenia/muscle weakness, abnormal weight loss, depression, and fatigue notably elevated the overall medical costs. To compare the total medical costs associated with operative versus non-operative medical procedures for femoral neck fractures in older adults with Alzheimer's disease (AD). This retrospective cohort study examined 4,157 Optum beneficiaries diagnosed with AD who filed an initial claim for femoral neck fracture between January 1, 2012, and December 31, 2017. Generalized linear regression with Gamma log link function was performed to evaluate total medical costs between surgical treatment and non-operative care while controlling for covariates. The adjusted total medical costs per patient for arthroplasty and internal fixation were $207,392 and $170,210, exceeding the total medical costs for non-operative cases ($63,041). Comorbidities such as history of falls, sarcopenia/muscle weakness, abnormal weight loss, depression, and fatigue also had a significant impact on the overall medical costs. Surgical intervention for femoral neck fractures incurs higher costs but offers better clinical outcomes than non-operative care.