Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, OR.
J Orthop Trauma. 2018 Jun;32(6):e198-e203. doi: 10.1097/BOT.0000000000001150.
To evaluate the cost effectiveness of suture buttons compared with syndesmotic screws for repair of tibiofibular syndesmotic injuries.
A decision tree model was constructed to describe outcomes after syndesmosis repair using suture buttons and syndesmotic screws from the perspective of a capitated health care system. Outcomes were uneventful healing, removal of symptomatic implants, deep infection, and persistent diastasis requiring revision. Weighted literature averages were used to estimate variables for a baseline model. Outcomes were measured in quality adjusted life years. Procedure and implant costs were derived from Medicare reimbursement rates and the University Health System Consortium. An incremental cost-effectiveness ratio threshold of $50,000 per quality-adjusted life years was used to evaluate cost effectiveness.
The baseline model did not identify suture buttons to be cost effective. Sensitivity analysis demonstrates the model to be exquisitely sensitive to small changes in reoperation rates and implant price. At median University Health System Consortium implant prices, if the removal rate for symptomatic screws is below 13.7%, then screws are cost effective. If the screw removal rate is greater than 17.5%, then a suture button is cost effective. Within this interval, detailed analysis of the model suggests that screws may be the cost-effective strategy, but that determination should be taken with caution.
Moving away from the practice of routinely removing all syndesmotic screws has changed the financial landscape of syndesmosis repair. At their median cost, suture buttons are likely to be cost effective over screws for symptomatic screw removal rates greater than 17.5%. Cost effectiveness is sensitive to changes in implant removal rates and the number of devices used per patient.
Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.
评估缝合扣与联合钉治疗下胫腓联合损伤的成本效果。
采用决策树模型，从人头付费医疗体系的角度描述使用缝合扣和联合钉修复下胫腓联合后的结果。结果包括无并发症愈合、去除有症状的植入物、深部感染和需要翻修的持续分离。使用加权文献平均值来估算基线模型的变量。结果以质量调整生命年来衡量。手术和植入物的成本来自医疗保险报销率和大学健康联盟。增量成本效益比阈值为 50000 美元/质量调整生命年，用于评估成本效益。
基线模型并未发现缝合扣具有成本效益。敏感性分析表明，该模型对再手术率和植入物价格的微小变化非常敏感。在大学健康联盟的中位数植入物价格下，如果有症状的螺钉取出率低于 13.7%，则螺钉具有成本效益。如果螺钉取出率大于 17.5%，则缝合扣具有成本效益。在这个区间内，对模型的详细分析表明，螺钉可能是更具成本效益的策略，但这一结论应谨慎得出。
不再常规取出所有联合钉的做法改变了下胫腓联合修复的财务状况。在中位数成本下，对于有症状的螺钉取出率大于 17.5%的患者，缝合扣可能比螺钉更具成本效益。成本效果对植入物取出率和每位患者使用的器械数量的变化敏感。
经济证据等级 IV。有关证据等级的完整描述，请参见作者须知。
