Department of Orthopaedics, University of British Columbia, Vancouver, Canada.
J Orthop Trauma. 2012 Nov;26(11):652-8. doi: 10.1097/BOT.0b013e31824aec42.
A recent multicenter randomized control trial demonstrated similar quality of life at 1 year after open reduction and internal fixation (ORIF) compared with nonoperative treatment for stress-positive unstable isolated lateral malleolar fractures. We sought to determine the cost-effectiveness of ORIF compared with nonoperative management of these isolated lateral malleolar fractures.
Cost-utility analysis using decision tree and Markov modeling based on data from a prospective randomized control trial and previously published literature. A single-payer perspective with 1-year and lifetime time horizons was adopted.
Clinical trial data from 6 Canadian level I trauma hospitals.
Lateral malleolus ORIF versus nonoperative treatment.
Incremental cost-effectiveness ratio (ICER).
The base case 1-year ICER of the ORIF treatment was $205,090 per quality-adjusted life year gained, favoring nonoperative treatment. For the lifetime time horizon, ORIF becomes the preferred treatment with an ICER of $16,404 per quality-adjusted life year gained. This conclusion is stable provided ORIF lowers the lifetime incidence of ankle arthrosis by >3% compared with nonoperative treatment. Probabilistic sensitivity analysis demonstrated that 33% of model simulations favored ORIF in the 1-year time horizon and 65% of simulations in the lifetime time horizon.
From a single-payer governmental perspective, ORIF does not seem to be cost effective in the 1-year time horizon; however, if operative fixation decreases the lifetime incidence of posttraumatic ankle arthrosis by >3%, then ORIF becomes the economically preferred treatment.
Economic Level II. See Instructions for Authors for a complete description of levels of evidence.
最近一项多中心随机对照试验表明，对于应力阳性不稳定型单纯外踝骨折，切开复位内固定（ORIF）与非手术治疗在 1 年时的生活质量相似。我们旨在确定 ORIF 与这些单纯外踝骨折的非手术治疗相比的成本效益。
基于前瞻性随机对照试验和先前发表的文献数据，使用决策树和马尔可夫模型进行成本效用分析。采用单一支付者视角，时间范围为 1 年和终生。
来自 6 家加拿大一级创伤医院的临床试验数据。
外踝 ORIF 与非手术治疗。
增量成本效益比（ICER）。
ORIF 治疗的基础案例 1 年 ICER 为每获得 1 个质量调整生命年的成本为 205090 美元，有利于非手术治疗。对于终生时间范围，ORIF 成为首选治疗方法，每获得 1 个质量调整生命年的 ICER 为 16404 美元。如果 ORIF 与非手术治疗相比降低了终生踝关节骨关节炎的发生率 >3%，则该结论是稳定的。概率敏感性分析表明，1 年时间范围内有 33%的模型模拟结果支持 ORIF，而终生时间范围内有 65%的模拟结果支持 ORIF。
从单一支付者政府的角度来看，ORIF 在 1 年时间范围内似乎没有成本效益；然而，如果手术固定降低了创伤后踝关节骨关节炎的终生发生率 >3%，那么 ORIF 成为经济上更优的治疗选择。
经济 II 级。有关证据水平的完整描述，请参见作者说明。
