Bone flap fixation with clamp-like devices or with titanium plates and screws: A cost-minimization analysis

Clamp-like devices such as Cranial LOOP have similar performance and safety than titanium plates and screws to fix the bone flap after a craniotomy. This raises the question of which of these methods is more cost-effective. This cost-minimization analysis compares the cost associated with each of these methods in the setting of an already published RCT.

The data from a previously published RCT was analyzed to assess the mean cost of bone flap fixation after craniotomy using Cranial LOOP or plates and screws; this analysis included the cost of the devices, the implantation time cost and the implantation instruments reprocessing cost. This data was then analyzed to model the global cost of the craniotomy fixation for a range of implant unitary costs.

As a median, craniotomies were fixed with 3 Cranial LOOP or with 4 sets of titanium plates and screws. Both the total and the unitary cost for the devices were significantly lower with Cranial LOOP than with plating systems (306.4±100.0€ vs 568.8±261.6€, p<0.001; 88.2±7.3€ vs 154.9±67.6€, p<0.001). The implantation time of Cranial LOOP was significantly shorter than that of plating systems (1.70±0.20min vs 6.27±1.88min, p<0.001). Cranial LOOP does not require implantation instruments, while the implantation kits for plating systems require reprocessing (washing and sterilization). In total, the craniotomy fixation with Cranial LOOP costs between 360.56€ and 370.77€ less than with plating systems.

The cost of craniotomy fixation with Cranial LOOP was half the cost of fixation with plating systems. In addition, not requiring instrument reprocessing for Cranial LOOP saved water and energy.