Trauma Unit (M.A.M.M. and M.M.J.W.), Department of Surgery (S.v.D.), Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands.
J Bone Joint Surg Am. 2020 Apr 1;102(7):609-616. doi: 10.2106/JBJS.19.00597.
To our knowledge, a health economic evaluation of volar plate fixation compared with plaster immobilization in patients with a displaced extra-articular distal radial fracture has not been previously conducted.
A cost-effectiveness analysis of a multicenter randomized controlled trial was performed. Ninety patients were randomly assigned to volar plate fixation or plaster immobilization. The use of resources per patient was documented prospectively for up to 12 months after randomization and included direct medical, direct non-medical, and indirect non-medical costs due to the distal radial fracture and the received treatment.
The mean quality-adjusted life-years (QALYs) at 12 months were higher in patients treated with volar plate fixation (mean QALY difference, 0.16 [bias-corrected and accelerated 95% confidence interval (CI), 0.07 to 0.27]). (The 95% CIs throughout are bias-corrected and accelerated.) In addition, the mean total costs per patient were lower in patients treated with volar plate fixation (mean difference, -$299 [95% CI, -$1,880 to $1,024]). The difference in costs per QALY was -$1,838 (95% CI, -$12,604 to $9,787), in favor of volar plate fixation. In a subgroup analysis of patients who had paid employment, the difference in costs per QALY favored volar plate fixation by -$7,459 (95% CI, -$23,919 to $3,233).
In adults with a displaced extra-articular distal radial fracture, volar plate fixation is a cost-effective intervention, especially in patients who had paid employment. Besides its better functional results, volar plate fixation is less expensive and provides a better quality of life than plaster immobilization.
Economic Level I. See Instructions for Authors for a complete description of levels of evidence.
据我们所知，尚未对关节外桡骨远端移位性骨折的掌侧钢板固定与石膏固定进行过卫生经济学评价。
对一项多中心随机对照试验进行了成本效益分析。90 名患者被随机分配至掌侧钢板固定或石膏固定组。前瞻性记录了每位患者随机分组后 12 个月内的资源使用情况，包括因桡骨远端骨折和接受的治疗而产生的直接医疗、直接非医疗和间接非医疗成本。
掌侧钢板固定组患者 12 个月时的平均质量调整生命年（QALY）更高（平均 QALY 差值为 0.16 [校正偏倚和加速 95%置信区间（CI），0.07 至 0.27]）。（整个置信区间均为校正偏倚和加速。）此外，掌侧钢板固定组患者的平均每位患者总成本更低（平均差值为-299 美元 [95%CI，-1880 美元至 1024 美元]）。每 QALY 的成本差异为-1838 美元（95%CI，-12604 美元至 9787 美元），有利于掌侧钢板固定。在有报酬就业的患者亚组分析中，每 QALY 的成本差异有利于掌侧钢板固定的幅度为-7459 美元（95%CI，-23919 美元至 3233 美元）。
在有移位的关节外桡骨远端骨折的成年人中，掌侧钢板固定是一种具有成本效益的干预措施，特别是在有报酬就业的患者中。除了更好的功能结果外，掌侧钢板固定的成本更低，且能提供比石膏固定更好的生活质量。
经济学证据级别 I。有关证据级别完整描述，请参见《作者须知》。
