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Choosing a strategy for the diagnostic management of suspected scaphoid fracture: a cost-effectiveness analysis
M M Tiel-van Buul1, T H Broekhuizen, E J van Beek
1Academic Medical Center, University of Amsterdam, The Netherlands.
Unlabelled:
To assess the cost-effectiveness of various strategies for the diagnostic management of clinically suspected scaphoid fracture, a decision-analytic model was built to evaluate three strategies and to compare them with a (clairvoyant) reference diagnostic management strategy.
Methods:
Evaluated strategies were: (A) repeated radiography up to 2 wk; (B) repeat radiography up to 6 wk; and (C) radiography, followed by bone scintigraphy in patients with negative initial radiographs. Therapy consisted of 12 wk of immobilization for a radiographically or scintigraphically proven fracture. Diagnostic costs, therapeutic costs, period of immobilization and nonunion rate were calculated for all three strategies. Estimates were derived from a descriptive management study using bone scintigraphy and available literature. Sensitivity analyses were performed.
Results:
Overall costs were 273.7, 317.7 and 316.1 European Currency Units (ECU) for Strategies A, B and C, respectively (1 ECU = 1.15 U.S. dollar). Strategy B led to the longest average period of immobilization (8.6 wk), while Strategy A resulted in the highest nonunion rate (4.7%). The costs per nonunion saved for the additional use of bone scintigraphy (Strategy C) was ECU 2618 when compared to Strategy A.
Conclusion:
The use of bone scintigraphy in the diagnostic management of scaphoid fractures is accurate, convenient for patients and cost-effective.