Routine fixation of humeral shaft fractures is cost-effective: cost-utility analysis of 215 patients at a mean of five years following nonoperative management
Aims: The primary aim was to estimate the cost-effectiveness of routine operative fixation for all patients with humeral shaft fractures. The secondary aim was to estimate the health economic implications of using a Radiographic Union Score for HUmeral fractures (RUSHU) of < 8 to facilitate sele...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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The British Editorial Society of Bone & Joint Surgery
2022-07-01
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| Series: | Bone & Joint Open |
| Subjects: | |
| Online Access: | https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.37.BJO-2022-0047.R1 |
| _version_ | 1811223074772615168 |
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| author | William M. Oliver Samuel G. Molyneux Timothy O. White Nick D. Clement Andrew D. Duckworth |
| author_facet | William M. Oliver Samuel G. Molyneux Timothy O. White Nick D. Clement Andrew D. Duckworth |
| author_sort | William M. Oliver |
| collection | DOAJ |
| description | Aims: The primary aim was to estimate the cost-effectiveness of routine operative fixation for all patients with humeral shaft fractures. The secondary aim was to estimate the health economic implications of using a Radiographic Union Score for HUmeral fractures (RUSHU) of < 8 to facilitate selective fixation for patients at risk of nonunion. Methods: From 2008 to 2017, 215 patients (mean age 57 yrs (17 to 18), 61% female (n = 130/215)) with a nonoperatively managed humeral diaphyseal fracture were retrospectively identified. Union was achieved in 77% (n = 165/215) after initial nonoperative management, with 23% (n = 50/215) uniting after surgery for nonunion. The EuroQol five-dimension three-level health index (EQ-5D-3L) was obtained via postal survey. Multiple regression was used to determine the independent influence of patient, injury, and management factors upon the EQ-5D-3L. An incremental cost-effectiveness ratio (ICER) of < £20,000 per quality-adjusted life-year (QALY) gained was considered cost-effective. Results: At a mean of 5.4 yrs (1.2 to 11.0), the mean EQ-5D-3L was 0.736 (95% confidence interval (CI) 0.697 to 0.775). Adjusted analysis demonstrated the EQ-5D-3L was inferior among patients who united after nonunion surgery (β = 0.103; p = 0.032). Offering routine fixation to all patients to reduce the rate of nonunion would be associated with increased treatment costs of £1,542/patient, but would confer a potential EQ-5D-3L benefit of 0.120/patient over the study period. The ICER of routine fixation was £12,850/QALY gained. Selective fixation based on a RUSHU < 8 at six weeks post-injury would be associated with reduced treatment costs (£415/patient), and would confer a potential EQ-5D-3L benefit of 0.335 per ‘at-risk patient’. Conclusion: Routine fixation for patients with humeral shaft fractures to reduce the rate of nonunion observed after nonoperative management appears to be a cost-effective intervention at five years post-injury. Selective fixation for patients at risk of nonunion based on their RUSHU may confer even greater cost-effectiveness, given the potential savings and improvement in health-related quality of life. Cite this article: Bone Jt Open 2022;3(7):566–572. |
| first_indexed | 2024-04-12T08:26:45Z |
| format | Article |
| id | doaj.art-cbaeca3826e14a179bd7050d9a7961aa |
| institution | Directory Open Access Journal |
| issn | 2633-1462 |
| language | English |
| last_indexed | 2024-04-12T08:26:45Z |
| publishDate | 2022-07-01 |
| publisher | The British Editorial Society of Bone & Joint Surgery |
| record_format | Article |
| series | Bone & Joint Open |
| spelling | doaj.art-cbaeca3826e14a179bd7050d9a7961aa2022-12-22T03:40:22ZengThe British Editorial Society of Bone & Joint SurgeryBone & Joint Open2633-14622022-07-013756657210.1302/2633-1462.37.BJO-2022-0047.R1Routine fixation of humeral shaft fractures is cost-effective: cost-utility analysis of 215 patients at a mean of five years following nonoperative managementWilliam M. Oliver0Samuel G. Molyneux1Timothy O. White2Nick D. Clement3Andrew D. Duckworth4Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UKEdinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UKEdinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UKEdinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UKEdinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UKAims: The primary aim was to estimate the cost-effectiveness of routine operative fixation for all patients with humeral shaft fractures. The secondary aim was to estimate the health economic implications of using a Radiographic Union Score for HUmeral fractures (RUSHU) of < 8 to facilitate selective fixation for patients at risk of nonunion. Methods: From 2008 to 2017, 215 patients (mean age 57 yrs (17 to 18), 61% female (n = 130/215)) with a nonoperatively managed humeral diaphyseal fracture were retrospectively identified. Union was achieved in 77% (n = 165/215) after initial nonoperative management, with 23% (n = 50/215) uniting after surgery for nonunion. The EuroQol five-dimension three-level health index (EQ-5D-3L) was obtained via postal survey. Multiple regression was used to determine the independent influence of patient, injury, and management factors upon the EQ-5D-3L. An incremental cost-effectiveness ratio (ICER) of < £20,000 per quality-adjusted life-year (QALY) gained was considered cost-effective. Results: At a mean of 5.4 yrs (1.2 to 11.0), the mean EQ-5D-3L was 0.736 (95% confidence interval (CI) 0.697 to 0.775). Adjusted analysis demonstrated the EQ-5D-3L was inferior among patients who united after nonunion surgery (β = 0.103; p = 0.032). Offering routine fixation to all patients to reduce the rate of nonunion would be associated with increased treatment costs of £1,542/patient, but would confer a potential EQ-5D-3L benefit of 0.120/patient over the study period. The ICER of routine fixation was £12,850/QALY gained. Selective fixation based on a RUSHU < 8 at six weeks post-injury would be associated with reduced treatment costs (£415/patient), and would confer a potential EQ-5D-3L benefit of 0.335 per ‘at-risk patient’. Conclusion: Routine fixation for patients with humeral shaft fractures to reduce the rate of nonunion observed after nonoperative management appears to be a cost-effective intervention at five years post-injury. Selective fixation for patients at risk of nonunion based on their RUSHU may confer even greater cost-effectiveness, given the potential savings and improvement in health-related quality of life. Cite this article: Bone Jt Open 2022;3(7):566–572.https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.37.BJO-2022-0047.R1humeral diaphysishumeral shaftfracturecost-effectivenessnonoperative managementfunctional bracingnonunionrushuhumeral shaft fractureseq-5d-3lhumeral fractureshumeral diaphyseal fracturesradiographsmedical comorbiditiesimmobilizationradial nerve palsy |
| spellingShingle | William M. Oliver Samuel G. Molyneux Timothy O. White Nick D. Clement Andrew D. Duckworth Routine fixation of humeral shaft fractures is cost-effective: cost-utility analysis of 215 patients at a mean of five years following nonoperative management Bone & Joint Open humeral diaphysis humeral shaft fracture cost-effectiveness nonoperative management functional bracing nonunion rushu humeral shaft fractures eq-5d-3l humeral fractures humeral diaphyseal fractures radiographs medical comorbidities immobilization radial nerve palsy |
| title | Routine fixation of humeral shaft fractures is cost-effective: cost-utility analysis of 215 patients at a mean of five years following nonoperative management |
| title_full | Routine fixation of humeral shaft fractures is cost-effective: cost-utility analysis of 215 patients at a mean of five years following nonoperative management |
| title_fullStr | Routine fixation of humeral shaft fractures is cost-effective: cost-utility analysis of 215 patients at a mean of five years following nonoperative management |
| title_full_unstemmed | Routine fixation of humeral shaft fractures is cost-effective: cost-utility analysis of 215 patients at a mean of five years following nonoperative management |
| title_short | Routine fixation of humeral shaft fractures is cost-effective: cost-utility analysis of 215 patients at a mean of five years following nonoperative management |
| title_sort | routine fixation of humeral shaft fractures is cost effective cost utility analysis of 215 patients at a mean of five years following nonoperative management |
| topic | humeral diaphysis humeral shaft fracture cost-effectiveness nonoperative management functional bracing nonunion rushu humeral shaft fractures eq-5d-3l humeral fractures humeral diaphyseal fractures radiographs medical comorbidities immobilization radial nerve palsy |
| url | https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.37.BJO-2022-0047.R1 |
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