Volar Plate Fixation in Adults with a Displaced Extra-Articular Distal Radial Fracture Is Cost-Effective
| Autor: | S. van Dieren, Marjolein A. M. Mulders, J. C. Goslings, Jan Paul M. Frölke, Niels W. L. Schep, Monique M. J. Walenkamp |
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| Přispěvatelé: | AMS - Restoration & Development, AMS - Rehabilitation & Development, Surgery, APH - Methodology |
| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty Randomization Cost-Benefit Analysis Subgroup analysis law.invention Fixation (surgical) Fracture Fixation Internal Randomized controlled trial law Fracture fixation Bone plate medicine Humans Orthopedics and Sports Medicine Prospective Studies Prospective cohort study Aged business.industry General Medicine Middle Aged Confidence interval Surgery Casts Surgical Reconstructive and regenerative medicine Radboud Institute for Molecular Life Sciences [Radboudumc 10] Quality of Life Female business Radius Fractures Bone Plates |
| Zdroj: | Journal of bone and joint surgery. American volume, 102(7), 609-616. Journal of Bone and Joint Surgery Inc. Journal of Bone and Joint Surgery. American Volume, 102, 7, pp. 609-616 Journal of Bone and Joint Surgery. American Volume, 102, 609-616 |
| ISSN: | 0021-9355 |
| Popis: | Contains fulltext : 226472.pdf (Publisher’s version ) (Closed access) BACKGROUND: To our knowledge, a health economic evaluation of volar plate fixation compared with plaster immobilization in patients with a displaced extra-articular distal radial fracture has not been previously conducted. METHODS: A cost-effectiveness analysis of a multicenter randomized controlled trial was performed. Ninety patients were randomly assigned to volar plate fixation or plaster immobilization. The use of resources per patient was documented prospectively for up to 12 months after randomization and included direct medical, direct non-medical, and indirect non-medical costs due to the distal radial fracture and the received treatment. RESULTS: The mean quality-adjusted life-years (QALYs) at 12 months were higher in patients treated with volar plate fixation (mean QALY difference, 0.16 [bias-corrected and accelerated 95% confidence interval (CI), 0.07 to 0.27]). (The 95% CIs throughout are bias-corrected and accelerated.) In addition, the mean total costs per patient were lower in patients treated with volar plate fixation (mean difference, -$299 [95% CI, -$1,880 to $1,024]). The difference in costs per QALY was -$1,838 (95% CI, -$12,604 to $9,787), in favor of volar plate fixation. In a subgroup analysis of patients who had paid employment, the difference in costs per QALY favored volar plate fixation by -$7,459 (95% CI, -$23,919 to $3,233). CONCLUSIONS: In adults with a displaced extra-articular distal radial fracture, volar plate fixation is a cost-effective intervention, especially in patients who had paid employment. Besides its better functional results, volar plate fixation is less expensive and provides a better quality of life than plaster immobilization. LEVEL OF EVIDENCE: Economic Level I. See Instructions for Authors for a complete description of levels of evidence. |
| Databáze: | OpenAIRE |
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