非移位桡骨远端骨折采用一周与三至五周石膏固定的成本效益分析：一项阶梯楔形整群随机对照试验
One week versus three to five weeks of plaster cast immobilization for nonreduced distal radius fractures, a cost effectiveness analysis embedded in a stepped wedge cluster randomized controlled trial.
作者信息
de Bruijn Marcel A N, Boersma Emily Z, van Silfhout Lysanne, Tromp Tjarda N, Adang Eddy M M, van de Krol Erik, Edwards Michael J R, Stirler Vincent M A, Hermans Erik
机构信息
Department of Trauma Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
Department of IQ Healthcare, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands.
出版信息
Eur J Health Econ. 2025 Jun 2. doi: 10.1007/s10198-025-01795-2.
OBJECTIVE
Distal radius fractures are commonly seen at the Emergency Department. In the Netherlands, non- or minimally displaced fractures are immobilized for 3-5 weeks. However, evidence suggests shorter immobilization yields similar or better functional outcome. There is a lack of cost-effectiveness studies investigating shorter duration of cast immobilization. This study investigates the cost-effectiveness of one week of plaster cast immobilization versus three to five weeks.
METHODS
Cost-effectiveness data was collected as part of the Cast-OFF 2 study which started the 1st of January 2022. A randomized stepped wedge cluster design was used with 11 hospitals, and 10 clusters, including patients with an isolated non- or minimally displaced distal radius fracture without fracture reduction. Costs on medical consumption, and productivity were scored with the local Electronical Patient Record, and questionnaires at week one, six, month six, and twelve. Cost-effectiveness was reported per Quality-Adjusted Life Year (QALY).
RESULTS
A total of 402 patients were included (control n = 197 vs intervention n = 205). No differences in QALY were observed (+ 0.02, CI [-0.02, 0.06]). Cost savings for the intervention group ranged from €31.94 to €322.41 depending on different scenarios. The future perspective scenario with reduction of one outpatient clinic visit showed a significant cost saving of €254.27 (CI [-467.33, -41.21]). No significant differences were observed in baseline characteristics.
CONCLUSION
One week of plaster cast immobilization for non- or minimally displaced distal radius fractures results in comparable or better cost savings compared to usual care. Adopting one week of cast immobilization as the new standard-of-care could reduce healthcare costs.
TRIAL REGISTRATION
Netherlands Trial Register NL9278. CMO: 2-21-7308.
目的
桡骨远端骨折在急诊科较为常见。在荷兰，无移位或轻度移位的骨折需固定3至5周。然而，有证据表明缩短固定时间能产生相似或更好的功能结果。目前缺乏关于缩短石膏固定时间的成本效益研究。本研究调查了一周石膏固定与三至五周石膏固定的成本效益。
方法
成本效益数据作为2022年1月1日开始的Cast - OFF 2研究的一部分进行收集。采用随机阶梯楔形整群设计，涉及11家医院和10个群组，纳入孤立性无移位或轻度移位的桡骨远端骨折且未进行骨折复位的患者。通过当地电子病历以及在第1周、第6周、第6个月和第12个月的问卷调查来记录医疗消耗成本和生产力。按质量调整生命年（QALY）报告成本效益。
结果
共纳入402例患者（对照组n = 197，干预组n = 205）。未观察到QALY有差异（+0.02，可信区间[-0.02, 0.06]）。干预组的成本节约范围为31.94欧元至322.41欧元，具体取决于不同情景。未来减少一次门诊就诊的情景显示成本显著节约254.27欧元（可信区间[-467.33, -41.21]）。基线特征未观察到显著差异。
结论
对于无移位或轻度移位的桡骨远端骨折，一周石膏固定与常规治疗相比可节省相当或更多成本。采用一周石膏固定作为新的护理标准可降低医疗成本。
试验注册
荷兰试验注册编号NL9278。CMO：2 - 21 - 7308。
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