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Selles CA, Mulders MAM, van Dieren S, et al. Cost Analysis of Volar Plate Fixation Versus Plaster Cast Immobilization for Intra-Articular Distal Radial Fractures. J Bone Joint Surg Am. 2021;103(21):1970-1976doi: 10.2106/JBJS.20.01345.
Selles, C. A., Mulders, M. A. M., van Dieren, S., Goslings, J. C., Schep, N. W. L. (2021). Cost Analysis of Volar Plate Fixation Versus Plaster Cast Immobilization for Intra-Articular Distal Radial Fractures. The Journal of bone and joint surgery. American volume, 103(21), 1970-1976. https://doi.org/10.2106/JBJS.20.01345
Selles, C A, et al. "Cost Analysis of Volar Plate Fixation Versus Plaster Cast Immobilization for Intra-Articular Distal Radial Fractures." The Journal of bone and joint surgery. American volume vol. 103,21 (2021): 1970-1976. doi: https://doi.org/10.2106/JBJS.20.01345
Selles CA, Mulders MAM, van Dieren S, Goslings JC, Schep NWL. Cost Analysis of Volar Plate Fixation Versus Plaster Cast Immobilization for Intra-Articular Distal Radial Fractures. J Bone Joint Surg Am. 2021 Nov 03;103(21):1970-1976. doi: 10.2106/JBJS.20.01345. PMID: 34314400.
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J Bone Joint Surg Am. 2021 Nov 03;103(21):1970-1976. doi: 10.2106/JBJS.20.01345.

Cost Analysis of Volar Plate Fixation Versus Plaster Cast Immobilization for Intra-Articular Distal Radial Fractures.

The Journal of bone and joint surgery. American volume

C A Selles, M A M Mulders, S van Dieren, J C Goslings, N W L Schep,

Affiliations

  1. Trauma Unit, Department of Surgery, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands.
  2. Department of Trauma and Hand Surgery, Maasstad Hospital, Rotterdam, the Netherlands.
  3. Department of Surgery, OLVG, Amsterdam, the Netherlands.

PMID: 34314400 DOI: 10.2106/JBJS.20.01345

Abstract

BACKGROUND: The aim of this study was to compare the cost-effectiveness and cost-utility between plaster cast immobilization and volar plate fixation for acceptably reduced intra-articular distal radial fractures.

METHODS: A cost-effectiveness analysis was conducted as part of a randomized controlled trial comparing operative (volar plate fixation) with nonoperative (plaster cast immobilization) treatment in patients between 18 and 75 years old with an acceptably reduced intra-articular distal radial fracture. Health-care utilization and use of resources per patient were documented prospectively and included direct medical costs, direct non-medical costs, and indirect costs. All analyses were performed according to the intention-to-treat principle.

RESULTS: The mean total cost per patient was $291 (95% bias-corrected and accelerated confidence interval [bcaCI] = -$1,286 to $1,572) higher in the operative group compared with the nonoperative group. The mean total number of quality-adjusted life-years (QALYs) gained at 12 months was significantly higher in the operative group than in the nonoperative group (mean difference = 0.15; 95% bcaCI = 0.056 to 0.243). The difference in the cost per QALY (incremental cost-effectiveness ratio [ICER]) was $2,008 (95% bcaCI = -$9,608 to $18,222) for the operative group compared with the nonoperative group, which means that operative treatment is more effective but also more expensive. Subgroup analysis including only patients with a paid job showed that the ICER was -$3,500 per QALY for the operative group with a paid job compared with the nonoperative group with a paid job, meaning that operative treatment is more effective and less expensive for patients with a paid job.

CONCLUSIONS: The difference in QALYs gained for the operatively treated group was equivalent to an additional 55 days of perfect health per year. In adult patients with an acceptably reduced intra-articular distal radial fracture, operative treatment is a cost-effective intervention, especially in patients with paid employment. Operative treatment is slightly more expensive than nonoperative treatment but provides better functional results and a better quality of life.

LEVEL OF EVIDENCE: Economic and Decision Analysis Level I. See Instructions for Authors for a complete description of levels of evidence.

Copyright © 2021 by The Journal of Bone and Joint Surgery, Incorporated.

Conflict of interest statement

Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/G640).

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