Intramedullary nailing versus external fixation for open tibia fractures in Tanzania: a cost analysis.

Autor:	Roberts HJ; Department of Orthopaedic Surgery, Institute for Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, CA., Donnelley CA; Department of Orthopaedic Surgery, Institute for Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, CA., Haonga BT; Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania., Kramer E; Yale University School of Medicine, New Haven, CT., Eliezer EN; Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania., Morshed S; Department of Orthopaedic Surgery, Institute for Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, CA., Shearer D; Department of Orthopaedic Surgery, Institute for Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, CA.
Jazyk:	angličtina
Zdroj:	OTA international : the open access journal of orthopaedic trauma [OTA Int] 2021 Aug 09; Vol. 4 (3), pp. e146. Date of Electronic Publication: 2021 Aug 09 (Print Publication: 2021).
DOI:	10.1097/OI9.0000000000000146
Abstrakt:	Objectives: Open tibia fractures pose a clinical and economic burden that is disproportionately borne by low-income countries. A randomized trial conducted by our group showed no difference in infection and nonunion comparing 2 treatments: external fixation (EF) and intramedullary nailing (IMN). Secondary outcomes favored IMN. In the absence of clear clinical superiority, we sought to compare costs between EF and IMN. Design: Secondary cost analysis. Setting: Single institution in Tanzania. Patients/participants: Adult patients with acute diaphyseal open tibia fractures who participated in a previous randomized controlled trial. Intervention: SIGN IMN versus monoplanar EF. Main Outcome Measurements: Direct costs of initial surgery and hospitalization and subsequent reoperation: implant, instrumentation, medications, disposable supplies, and personnel costs.Indirect costs from lost productivity of patient and caregiver.Societal (total) costs: sum of direct and indirect costs.All costs were reported in 2018 USD. Results: Two hundred eighteen patients were included (110 IMN, 108 EF). From a payer perspective, costs were $365.83 (95% CI: $332.75-405.76) for IMN compared with $331.25 ($301.01-363.14) for EF, whereas from a societal perspective, costs were $2664.59 ($1711.22-3955.25) for IMN and $2560.81 ($1700.54-3715.09) for EF. The largest drivers of cost were reoperation and lost productivity. Accounting for uncertainty in multiple variables, probabilistic sensitivity analysis demonstrated that EF was less costly than IMN from the societal perspective in only 55% of simulations. Conclusions: Intramedullary nail fixation compared with external fixation of open tibia fractures in a resource-constrained setting is not associated with increased cost from a societal perspective. Competing Interests: The authors have no conflicts of interest to disclose. (Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Orthopaedic Trauma Association.)
Databáze:	MEDLINE
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