Bouklouch Yasser, Sen Milan
Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
Albert Einstein College of Medicine, Bronx, New York.
J Bone Joint Surg Am. 2025 Jun 25;107(16):1787-1797. doi: 10.2106/JBJS.24.00009.
The diagnosis of acute compartment syndrome (ACS) using a single-point pressure measurement device has demonstrated low specificity. Recently, sensors that allow for continuous monitoring of compartment pressure have been introduced, with improved specificity and sensitivity compared with single-point measurement. In this article, we present an economic model used to evaluate the cost-benefits of continuous pressure measurement in patients at risk for ACS.
The model used a decision-tree structure to estimate the treatment costs of ACS at 60 days and 1 year after admission and over the patient's lifetime. It assumed systematic use of the diagnostic devices for all tibial shaft and tibial plateau fractures and estimated the cost-effectiveness of continuous pressure measurement compared with noncontinuous pressure measurement by comparing costs, quality-adjusted life-years (QALYs), and length of stay (LOS).
The improved specificity of continuous pressure measurement reduced unnecessary fasciotomies by 94%. The inflation-adjusted cost of an uncomplicated tibial fracture averaged $57,144; the performance of an unnecessary fasciotomy increased that cost by $27,790. The gain in QALYs was 0.004 per patient, with a net health benefit of 0.06 QALYs. Over a 60-day time horizon, the model showed an estimated decrease in LOS of 2.73 days, on average, per patient. The net monetary benefit was $2,789 (range, -$1,246 to $6,151) in favor of the continuous measurement, increasing to $4,085 (range, -$745 to $8,103) over the lifetime of the patient following the most conservative scenario of equal ACS grade distribution.
Most of the ACS economic burden lies in the lack of specificity of the current diagnostic methods. The low incidence of ACS and the high risk associated with prophylactic treatment indicate that improvement in health and economic outcomes should focus on reducing the rate of unnecessary fasciotomies.
Economic and Decision Analysis Level IV . See Instructions for Authors for a complete description of levels of evidence.
使用单点压力测量装置诊断急性骨筋膜室综合征（ACS）的特异性较低。最近，已推出可连续监测骨筋膜室内压力的传感器，与单点测量相比，其特异性和敏感性有所提高。在本文中，我们提出了一种经济模型，用于评估对有ACS风险的患者进行连续压力测量的成本效益。
该模型采用决策树结构来估算入院后60天、1年及患者终身的ACS治疗成本。它假定对所有胫骨干和胫骨平台骨折系统地使用诊断设备，并通过比较成本、质量调整生命年（QALY）和住院时间（LOS）来估计连续压力测量与非连续压力测量相比的成本效益。
连续压力测量提高的特异性使不必要的筋膜切开术减少了94%。单纯胫骨骨折经通胀调整后的平均成本为57,144美元；不必要的筋膜切开术会使成本增加27,790美元。每位患者的QALY增益为0.004，净健康效益为0.06 QALY。在60天的时间范围内，该模型显示每位患者的LOS平均估计减少2.73天。连续测量的净货币效益为2,789美元（范围为 -1,246美元至6,151美元），在最保守的ACS分级分布相等的情况下，患者终身的净货币效益增加到4,085美元（范围为 -745美元至8,103美元）。
ACS的大部分经济负担在于当前诊断方法缺乏特异性。ACS的低发病率和预防性治疗的高风险表明，改善健康和经济结果应侧重于降低不必要的筋膜切开术发生率。
经济和决策分析IV级。有关证据水平的完整描述，请参阅作者指南。
