van Gerven P, van Dongen J M, Rubinstein S M, Termaat M F, El Moumni M, Zuidema W P, Krijnen P, Schipper I B, van Tulder M W
Department of Traumasurgery, Leiden University Medical Center, P.O. Box 9600, 2300, RC, Leiden, the Netherlands.
Department of Health Sciences, Faculty of Science, Amsterdam Movement Sciences research institute, Vrije Universiteit, Amsterdam, the Netherlands.
BMC Health Serv Res. 2020 Sep 22;20(1):893. doi: 10.1186/s12913-020-05725-1.
To evaluate the cost-effectiveness of a reduction in the number of routine radiographs in the follow-up of patients with ankle fractures.
We performed an economic evaluation alongside the multicentre, randomised WARRIOR trial. Participants were randomised to a reduced imaging follow-up protocol (i.e. radiographs at week 6 and 12 follow-up obtained on clinical indication) or usual care (i.e. routine radiography at weeks 6 and 12). The Olerud & Molander Ankle Score (OMAS) was used to assess ankle function and the EQ-5D-3L was used to estimate Quality-Adjusted Life Years (QALYs). Costs and resource use were assessed using self-reported questionnaires and medical records, and analysed from a societal perspective. Multiple imputation was used for missing data, and data were analysed using seemingly unrelated regression analysis and bootstrapping.
In total, 246 patients had data available for analysis (reduced imaging = 118; usual care = 128). Fewer radiographs were obtained in the reduced imaging group (median = 4) compared with the usual-care group (median = 5). Functional outcome was comparable in both groups. The difference in QALYs was - 0.008 (95% CI:-0.06 to 0.04) and the difference in OMAS was 0.73 (95% CI:-5.29 to 6.76). Imaging costs were lower in the reduced imaging group (-€48; 95% CI:- €72 to -€25). All other cost categories did not statistically differ between the groups. The probability of the reduced imaging protocol being cost-effectiveness was 0.45 at a wiliness-to-pay of €20,000 per QALY.
Reducing the number of routine follow-up radiographs has a low probability of being cost-effective compared with usual care. Functional outcome, health-related quality of life and societal costs were comparable in both groups, whereas imaging costs were marginally lower in the reduced imaging group. Given this, adherence to a reduced imaging follow-up protocol for those with routine ankle fractures can be followed without sacrificing quality of care, and may result in reduced costs.
The trial was registered on 26-05-2014 in the Netherlands Trial Registry, with reference number NL4477 ( www.trialregister.nl/trial/4477 ).
评估减少踝关节骨折患者随访中常规X光片数量的成本效益。
我们在多中心随机WARRIOR试验的同时进行了一项经济评估。参与者被随机分配到减少影像随访方案组（即根据临床指征在第6周和第12周随访时拍摄X光片）或常规治疗组（即在第6周和第12周进行常规X光检查）。使用奥勒鲁德和莫兰德踝关节评分（OMAS）评估踝关节功能，使用EQ-5D-3L评估质量调整生命年（QALY）。使用自我报告问卷和医疗记录评估成本和资源使用情况，并从社会角度进行分析。对缺失数据采用多重插补法，并使用看似不相关回归分析和自抽样法进行数据分析。
共有246例患者的数据可供分析（减少影像组=118例；常规治疗组=128例）。与常规治疗组（中位数=5）相比，减少影像组获得的X光片更少（中位数=4）。两组的功能结局相当。QALY的差异为-0.008（95%CI：-0.06至0.04），OMAS的差异为0.73（95%CI：-5.29至6.76）。减少影像组的影像成本较低（-48欧元；95%CI：-72至-25欧元）。两组之间所有其他成本类别在统计学上无差异。在每QALY支付意愿为20,000欧元时，减少影像方案具有成本效益的概率为0.45。
与常规治疗相比，减少常规随访X光片数量具有成本效益的可能性较低。两组的功能结局、健康相关生活质量和社会成本相当，而减少影像组的影像成本略低。鉴于此，对于常规踝关节骨折患者遵循减少影像随访方案，在不牺牲护理质量的情况下可能会降低成本。
该试验于2014年5月26日在荷兰试验注册中心注册，注册号为NL4477（www.trialregister.nl/trial/4477）。
