Surgical treatment is not cost-effective compared to nonoperative treatment for displaced distal radius fractures in patients 65 years and over
Aims: The purpose was to compare operative treatment with a volar plate and nonoperative treatment of displaced distal radius fractures in patients aged 65 years and over in a cost-effectiveness analysis. Methods: A cost-utility analysis was performed alongside a randomized controlled trial. A total...
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| Format: | Article |
| Language: | English |
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The British Editorial Society of Bone & Joint Surgery
2021-12-01
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| Series: | Bone & Joint Open |
| Subjects: | |
| Online Access: | https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.212.BJO-2021-0108.R1 |
| _version_ | 1818362849428242432 |
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| author | Sondre Hassellund Zinajda Zolic-Karlsson John Håkon Williksen Torstein Husby Jan Erik Madsen Frede Frihagen |
| author_facet | Sondre Hassellund Zinajda Zolic-Karlsson John Håkon Williksen Torstein Husby Jan Erik Madsen Frede Frihagen |
| author_sort | Sondre Hassellund |
| collection | DOAJ |
| description | Aims: The purpose was to compare operative treatment with a volar plate and nonoperative treatment of displaced distal radius fractures in patients aged 65 years and over in a cost-effectiveness analysis. Methods: A cost-utility analysis was performed alongside a randomized controlled trial. A total of 50 patients were randomized to each group. We prospectively collected data on resource use during the first year post-fracture, and estimated costs of initial treatment, further operations, physiotherapy, home nursing, and production loss. Health-related quality of life was based on the Euro-QoL five-dimension, five-level (EQ-5D-5L) utility index, and quality-adjusted life-years (QALYs) were calculated. Results: The mean QALYs were 0.05 higher in the operative group during the first 12 months (p = 0.260). The healthcare provider costs were €1,533 higher per patient in the operative group: €3,589 in the operative group and 2,056 in the nonoperative group. With a suggested willingness to pay of €27,500 per QALY there was a 45% chance for operative treatment to be cost-effective. For both groups, the main costs were related to the primary treatment. The primary surgery was the main driver of the difference between the groups. The costs related to loss of production were high in both groups, despite high rates of retirement. Retirement rate was unevenly distributed between the groups and was not included in the analysis. Conclusion: Surgical treatment was not cost-effective in patients aged 65 years and older compared to nonoperative treatment of displaced distal radius fractures in a healthcare perspective. Costs related to loss of production might change this in the future if the retirement age increases. Level of evidence: II Cite this article: Bone Jt Open 2021;2(12):1027–1034. |
| first_indexed | 2024-12-13T21:39:07Z |
| format | Article |
| id | doaj.art-d8283a9fb39d4d79a0386c1b262874cc |
| institution | Directory Open Access Journal |
| issn | 2633-1462 |
| language | English |
| last_indexed | 2024-12-13T21:39:07Z |
| publishDate | 2021-12-01 |
| publisher | The British Editorial Society of Bone & Joint Surgery |
| record_format | Article |
| series | Bone & Joint Open |
| spelling | doaj.art-d8283a9fb39d4d79a0386c1b262874cc2022-12-21T23:30:36ZengThe British Editorial Society of Bone & Joint SurgeryBone & Joint Open2633-14622021-12-012121027103410.1302/2633-1462.212.BJO-2021-0108.R1Surgical treatment is not cost-effective compared to nonoperative treatment for displaced distal radius fractures in patients 65 years and overSondre Hassellund0Zinajda Zolic-Karlsson1John Håkon Williksen2Torstein Husby3Jan Erik Madsen4Frede Frihagen5Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, NorwayNorwegian Medicines Agency, Skøyen, NorwayDivision of Orthopaedic Surgery, Oslo University Hospital, Oslo, NorwayDivision of Orthopaedic Surgery, Oslo University Hospital, Oslo, NorwayDivision of Orthopaedic Surgery, Oslo University Hospital, Oslo, NorwayInstitute of Clinical Medicine, University of Oslo, Oslo, NorwayAims: The purpose was to compare operative treatment with a volar plate and nonoperative treatment of displaced distal radius fractures in patients aged 65 years and over in a cost-effectiveness analysis. Methods: A cost-utility analysis was performed alongside a randomized controlled trial. A total of 50 patients were randomized to each group. We prospectively collected data on resource use during the first year post-fracture, and estimated costs of initial treatment, further operations, physiotherapy, home nursing, and production loss. Health-related quality of life was based on the Euro-QoL five-dimension, five-level (EQ-5D-5L) utility index, and quality-adjusted life-years (QALYs) were calculated. Results: The mean QALYs were 0.05 higher in the operative group during the first 12 months (p = 0.260). The healthcare provider costs were €1,533 higher per patient in the operative group: €3,589 in the operative group and 2,056 in the nonoperative group. With a suggested willingness to pay of €27,500 per QALY there was a 45% chance for operative treatment to be cost-effective. For both groups, the main costs were related to the primary treatment. The primary surgery was the main driver of the difference between the groups. The costs related to loss of production were high in both groups, despite high rates of retirement. Retirement rate was unevenly distributed between the groups and was not included in the analysis. Conclusion: Surgical treatment was not cost-effective in patients aged 65 years and older compared to nonoperative treatment of displaced distal radius fractures in a healthcare perspective. Costs related to loss of production might change this in the future if the retirement age increases. Level of evidence: II Cite this article: Bone Jt Open 2021;2(12):1027–1034.https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.212.BJO-2021-0108.R1distal radius fracturecolle's fracturecost-benefithealth economic evaluationnonoperative treatmentfractures of the distal radiusnonoperative treatmentsurgical treatmentrandomized controlled trialeq-5d-5lprimary surgeryphysiotherapyvolar locking platesquick-dashdisplaced fractures |
| spellingShingle | Sondre Hassellund Zinajda Zolic-Karlsson John Håkon Williksen Torstein Husby Jan Erik Madsen Frede Frihagen Surgical treatment is not cost-effective compared to nonoperative treatment for displaced distal radius fractures in patients 65 years and over Bone & Joint Open distal radius fracture colle's fracture cost-benefit health economic evaluation nonoperative treatment fractures of the distal radius nonoperative treatment surgical treatment randomized controlled trial eq-5d-5l primary surgery physiotherapy volar locking plates quick-dash displaced fractures |
| title | Surgical treatment is not cost-effective compared to nonoperative treatment for displaced distal radius fractures in patients 65 years and over |
| title_full | Surgical treatment is not cost-effective compared to nonoperative treatment for displaced distal radius fractures in patients 65 years and over |
| title_fullStr | Surgical treatment is not cost-effective compared to nonoperative treatment for displaced distal radius fractures in patients 65 years and over |
| title_full_unstemmed | Surgical treatment is not cost-effective compared to nonoperative treatment for displaced distal radius fractures in patients 65 years and over |
| title_short | Surgical treatment is not cost-effective compared to nonoperative treatment for displaced distal radius fractures in patients 65 years and over |
| title_sort | surgical treatment is not cost effective compared to nonoperative treatment for displaced distal radius fractures in patients 65 years and over |
| topic | distal radius fracture colle's fracture cost-benefit health economic evaluation nonoperative treatment fractures of the distal radius nonoperative treatment surgical treatment randomized controlled trial eq-5d-5l primary surgery physiotherapy volar locking plates quick-dash displaced fractures |
| url | https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.212.BJO-2021-0108.R1 |
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