[ Objective] To analyze the Cost-effectiveness of the treatment of unstable intertrochanteric fractures in the elderly with proximal femoral nail anti-rotation and artificial femoral head prosthetic replacement provides a basis for rational selection of surgical plans. [Methods] A retrospective analysis of 126 patients with unstable intertrochanteric fractures in the elderly from January 2016 to April 2018 in our hospital was randomly divided into two groups: 65 patients in the PFNA group and 61 patients in the FHR group. The cost of fractures within 1 year was evaluated by the hip fracture function recovery scale, and the cost-effectiveness ratio and incremental cost-effectiveness ratio of the two groups were compared. [Results] The cost of treatment in the PFNA group and the FHR group was 50707.61 yuan and 59429.91 yuan in one year after fracture. The FRS scores in the one-year postoperative period were 72.64 points and 75.01 points respectively. The average cost per time was 1698.07 yuan and 792.29. Yuan; FHR group and the PFNA group scored 1368 more for each extra point. [Conclusion] The proximal femoral nail and artificial femoral head replacement can achieve satisfactory results in the treatment of unstable intertrochanteric fractures in the elderly. However, the cost of PFNA is lower, which may be more economical from the perspective of health economics.