Hammer Ola-Lars, Jakobsen Rune Bruhn, Clementsen Stale, Fuglesang Hendrik, Bjornelv Gudrun Waaler, Randsborg Per-Henrik
Akershus University Hospital, Akershus, Norway.
University of Oslo, Oslo, Norway.
J Bone Joint Surg Am. 2020 Dec 2;102(23):2049-2059. doi: 10.2106/JBJS.19.01288.
The purpose of the present study was to estimate the cost-effectiveness of treating displaced, intra-articular distal radial fractures with volar locking plate fixation compared with augmented external fixation.
A cost-utility analysis was conducted alongside a randomized, clinical trial comparing 2 surgical interventions for intra-articular distal radial fractures. One hundred and sixty-six patients were allocated to either volar locking plate fixation (84 patients) or external fixation (82 patients) and were followed for 2 years. Health-related quality of life was assessed with the EuroQol-5 Dimensions and was used to calculate patients' quality-adjusted life-years (QALYs). Resource use was identified prospectively at the patient level at all follow-up intervals. Costs were estimated with use of both a health-care perspective and a societal perspective. Results were expressed in incremental cost-effectiveness ratios, and uncertainty was assessed with use of bootstrapping methods.
The average QALY value was equivalent between the groups (1.70463 for the volar locking plate group and 1.70726 for the external fixation group, yielding a nonsignificant difference of -0.00263 QALY). Health-care costs were equal between the groups, with a nonsignificant difference of &OV0556;52 (p = 0.8) in favor of external fixation. However, the external fixation group had a higher loss of productivity due to absence from work (5.5 weeks in the volar locking plate group compared with 9.2 weeks for the external fixation group; p = 0.02). Consequently, the societal costs were higher for the external fixation group compared with the volar locking plate group (&OV0556;18,037 compared with &OV0556;12,567, representing a difference of &OV0556;5,470; p = 0.04) in favor of the volar locking plate group. Uncertainty analyses showed that there is indifference regarding which method to recommend from a health-care perspective, with volar locking plate treatment and external fixation having a 47% and 53% likelihood of being cost-effective, respectively. From the societal perspective, volar locking plate treatment had a 90% likelihood of being cost-effective.
External fixation was less cost-effective than volar locking plate treatment for distal radial fractures from a societal perspective, primarily because patients managed with external fixation had a longer absence from work.
Economic and Decision Analysis Level I. See Instructions for Authors for a complete description of levels of evidence.
本研究的目的是评估与增强外固定相比，采用掌侧锁定钢板固定治疗移位的桡骨远端关节内骨折的成本效益。
在一项比较两种治疗桡骨远端关节内骨折手术干预措施的随机临床试验的同时进行成本效用分析。166例患者被分配至掌侧锁定钢板固定组（84例患者）或外固定组（82例患者），并随访2年。采用欧洲五维健康量表评估与健康相关的生活质量，并用于计算患者的质量调整生命年（QALY）。在所有随访期间前瞻性地确定患者层面的资源使用情况。从医疗保健角度和社会角度估计成本。结果以增量成本效益比表示，并采用自抽样法评估不确定性。
两组的平均QALY值相当（掌侧锁定钢板组为1.70463，外固定组为1.70726，差异不显著，为-0.00263 QALY）。两组的医疗保健成本相等，外固定组有&OV0556;52的非显著差异（p = 0.8），有利于外固定。然而，外固定组因缺勤导致的生产力损失更高（掌侧锁定钢板组为5.5周，外固定组为9.2周；p = 0.02）。因此，外固定组的社会成本高于掌侧锁定钢板组（&OV0556;18,037比&OV0556;12,567，相差&OV0556;5,470；p = 0.04），有利于掌侧锁定钢板组。不确定性分析表明，从医疗保健角度来看，推荐哪种方法并无差异，掌侧锁定钢板治疗和外固定具有成本效益的可能性分别为47%和53%。从社会角度来看，掌侧锁定钢板治疗具有成本效益的可能性为90%。
从社会角度来看，外固定治疗桡骨远端骨折的成本效益低于掌侧锁定钢板治疗，主要是因为接受外固定治疗的患者缺勤时间更长。
经济和决策分析I级。有关证据水平的完整描述，请参阅作者须知。
