From the Department of Surgery (J.C., L.T., D.A.S., J.D.F.), Division of General Surgery, Department of Epidemiology and Population Health (J.C.), Surgeons Writing About Trauma (J.C., B.M., R.T., L.T., D.A.S., J.D.F.), and School of Medicine (B.M., R.T.), Stanford University, Stanford, California; Department of Surgery, Chulalongkorn University (W.L.), Bangkok, Thailand; and Stanford Health Policy (J.A.S., J.D.G.-F.), Centers for Health Policy and Primary Care and Outcomes Research, Stanford University, Stanford, California.
J Trauma Acute Care Surg. 2021 Mar 1;90(3):451-458. doi: 10.1097/TA.0000000000003021.
Surgical stabilization of rib fracture (SSRF) is increasingly used to manage patients with rib fractures. Benefits of performing SSRF appear variable, and the procedure is costly, necessitating cost-effectiveness analysis for distinct subgroups. We aimed to assess the cost-effectiveness of SSRF versus nonoperative management among patients with rib fractures younger than 65 years versus 65 years or older, with versus without flail chest. We hypothesized that, compared with nonoperative management, SSRF is cost-effective only for patients with flail chest.
This economic evaluation used a decision-analytic Markov model with a lifetime time horizon incorporating US population-representative inputs to simulate benefits and risks of SSRF compared with nonoperative management. We report quality-adjusted life years (QALYs), costs, and incremental cost-effectiveness ratios. Deterministic and probabilistic sensitivity analyses accounted for most plausible clinical scenarios.
Compared with nonoperative management, SSRF was cost-effective for patients with flail chest at willingness-to-pay threshold of US $150,000/QALY gained. Surgical stabilization of rib fracture costs US $25,338 and US $123,377/QALY gained for those with flail chest younger than 65 years and 65 years or older, respectively. Surgical stabilization of rib fracture was not cost-effective for patients without flail chest, costing US $172,704 and US $243,758/QALY gained for those younger than 65 years and 65 years or older, respectively. One-way sensitivity analyses showed that, under most plausible scenarios, SSRF remained cost-effective for subgroups with flail chest, and nonoperative management remained cost-effective for patients older than 65 years without flail chest. Probability that SSRF is cost-effective ranged from 98% among patients younger than 65 years with flail chest to 35% among patients 65 years or older without flail chest.
Surgical stabilization of rib fracture is cost-effective for patients with flail chest. Surgical stabilization of rib fracture may be cost-effective in some patients without flail chest, but delineating these patients requires further study.
Economic/decision, level II.
肋骨骨折的手术固定（SSRF）越来越多地用于治疗肋骨骨折患者。实施 SSRF 的益处似乎各不相同，而且该手术费用昂贵，因此需要对不同亚组进行成本效益分析。我们旨在评估对于年龄小于 65 岁和 65 岁或以上、有或没有连枷胸的肋骨骨折患者，SSRF 与非手术治疗相比的成本效益。我们假设，与非手术治疗相比，SSRF 仅对连枷胸患者具有成本效益。
本经济评估使用决策分析马尔可夫模型，具有终生时间范围，并纳入了具有代表性的美国人群输入，以模拟 SSRF 与非手术治疗相比的益处和风险。我们报告了质量调整生命年（QALY）、成本和增量成本效益比。确定性和概率敏感性分析考虑了最合理的临床情况。
与非手术治疗相比，在愿意支付 150,000 美元/QALY 的阈值下，SSRF 对于连枷胸患者具有成本效益。对于年龄小于 65 岁和 65 岁或以上的有连枷胸患者，SSRF 的成本分别为 25,338 美元和 123,377 美元/QALY 获得。对于没有连枷胸的患者，SSRF 并不具有成本效益，成本分别为 172,704 美元和 243,758 美元/QALY 获得，年龄小于 65 岁和 65 岁或以上的患者。单因素敏感性分析表明，在大多数合理的情况下，SSRF 对于有连枷胸的亚组仍然具有成本效益，而对于没有连枷胸的 65 岁以上患者，非手术治疗仍然具有成本效益。SSRF 具有成本效益的概率范围从年龄小于 65 岁有连枷胸的患者的 98%到 65 岁或以上没有连枷胸的患者的 35%。
对于有连枷胸的患者，肋骨骨折的手术固定是具有成本效益的。对于没有连枷胸的某些患者，SSRF 可能具有成本效益，但需要进一步研究来确定这些患者。
经济/决策，二级。
