ORIGINAL RESEARCH article
Front. Surg.
Sec. Orthopedic Surgery
FHR versus 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
Mingliang He
Yuhao Yan
Xuanze Liu
Guoqing Xiao
The Second Affiliated Hospital of Chengdu Medical College (China National Nuclear Corporation 416 Hospital), Chengdu, China
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Abstract
Objective: 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. Methods：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. Results: 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. Conclusion: 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.
Summary
Keywords
cost-effectiveness analysis, elderly adults, Femoral neck basicervical fracture, FHR, PFNA, QALY
Received
13 October 2025
Accepted
17 February 2026
Copyright
© 2026 He, Yan, Liu and Xiao. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Guoqing Xiao
Disclaimer
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.