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Cost-effectiveness analysis of the Ottawa Ankle Rules
A H Anis1, I G Stiell, D G Stewart
1Department of Health Care and Epidemiology, University of British Columbia, Vancouver, Canada.
Annals of Emergency Medicine
|October 1, 1995
Summary
Implementing the Ottawa Ankle Rules in emergency departments significantly saves healthcare costs in the US and Canada. This clinical decision rule reduces radiography use and associated expenses, even accounting for potential missed fractures and litigation.
Area of Science:
- Health Economics
- Clinical Decision Science
- Emergency Medicine
Background:
- Emergency departments (EDs) frequently use radiography for ankle injuries, leading to high costs.
- The Ottawa Ankle Rules offer a guideline to reduce unnecessary radiography.
- Current practice patterns and cost-effectiveness of these rules require analysis.
Purpose of the Study:
- To perform an incremental cost-effectiveness analysis of implementing the Ottawa Ankle Rules in US and Canadian emergency departments.
- To compare the cost-effectiveness of the Ottawa Ankle Rules against current radiography practices.
Main Methods:
- A decision analytic model was used for technology assessment.
- The study simulated the use of the Ottawa Ankle Rules by ED physicians for adult ankle injuries.
- Costs analyzed included radiography, waiting times, lost productivity, and medicolegal expenses.
Main Results:
- Implementation of the Ottawa Ankle Rules resulted in substantial cost savings per 100,000 patients in both the United States (US$614,226–US$3,145,910) and Ontario, Canada (CAN$730,145).
- Sensitivity analyses confirmed the robustness of these savings across various parameters like missed fracture rates and litigation costs.
- The rules allow for more selective radiography use, improving efficiency.
Conclusions:
- The Ottawa Ankle Rules implementation is cost-effective, generating significant healthcare savings.
- These savings are achievable even when considering the costs associated with missed fractures and potential litigation.
- Adoption of the Ottawa Ankle Rules is recommended for economic efficiency in emergency care settings.