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Minimally Invasive Treatment for Thoracolumbar Burst Fracture Using Sagittal Alignment Screws and A Trauma Reduction Device
Published on: November 8, 2024
Is surgery for displaced, midshaft clavicle fractures in adults cost-effective? Results based on a multicenter
Adam M Pearson1, Anna N A Tosteson, Kenneth J Koval
1Dartmouth-Hitchcock Medical Center, Lebanon, NH 03755, USA. adam.pearson@hitchcock.org
Objectives:
To determine the cost-effectiveness of open reduction internal fixation (ORIF) of displaced, midshaft clavicle fractures in adults.
Design:
Formal cost-effectiveness analysis based on a prospective, randomized, controlled trial.
Setting:
Eight hospitals in Canada (seven university-affiliated and one community hospital).
Patients/Participants:
One hundred thirty-two adults with acute, completely displaced, midshaft clavicle fractures.
Intervention:
Clavicle ORIF versus nonoperative treatment.
Main Outcome Measurements:
Utilities derived from SF-6D.
Results:
The base case cost per quality-adjusted life-year (QALY) gained for ORIF was $65,000. Cost-effectiveness improved to $28,150/QALY gained when the functional benefit from ORIF was assumed to be permanent with cost per QALY gained falling below $50,000 when the functional advantage persisted for 9.3 years or more. In other sensitivity analyses, the cost per QALY gained for ORIF fell below $50,000 when ORIF cost less than $10,465 (base case cost $13,668) or the long-term utility difference between nonoperative treatment and ORIF was greater than 0.034 (base case difference 0.014). Short-term disutility associated with fracture healing also affected cost-effectiveness with the cost per QALY gained for ORIF falling below $50,000 when the utility of a fracture treated nonoperatively before union was less than 0.617 (base case utility 0.706) or when nonoperative treatment increased the time to union by 20 weeks (base case difference 12 weeks).
Conclusions:
The cost-effectiveness of ORIF after acute clavicle fracture depended on the durability of functional advantage for ORIF compared with nonoperative treatment. When functional benefits persisted for more than 9 years, ORIF had a favorable value compared with many accepted health interventions.
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Minor fractures with no bone displacement are treated by immobilizing the fractured bone using a cast or splint. However, in the case of fractures with displaced bones, the broken bones are repositioned before immobilization to ensure successful healing without deformation and loss of function. The realignment of fractured bone ends is performed through a process called reduction. If the procedure...