Coyte P C, Bronskill S E, Hirji Z Z, Daigle-Takacs G, Trerise B S, Wright J G
Department of Health Administration, University of Toronto, Ontario, Canada.
Clin Orthop Relat Res. 1997 Mar(336):205-15. doi: 10.1097/00003086-199703000-00029.
The purpose of this study was to assess the relative health system costs of early hip spica cast immobilization and external fixation for pediatric femoral shaft fractures. A cost analysis was performed from the viewpoint of the study hospital and physicians using protocols based on current practice. Cost estimates were based on patient and financial information from April 1, 1993, to January 31, 1994, including the fully allocated inpatient and outpatient costs. A sensitivity analysis was conducted to analyze the effect of complications on costs. Total estimated costs (in 1994 Canadian dollars, $1.00 = $0.75 US) of uncomplicated external fixation and hip spica treatments were $7626.30 and $5970.11, respectively. Fifty percent of this difference was attributable to longer inpatient stays for the external fixation treatment. The remaining difference was because of the cost of the fixator, additional operating room staff time costs, and additional professional and technical fees. Total expected costs of treatment complicated by loss of reduction, pin tract infection, and return to the operating room were $7716.01 and $6128.44 for the external fixation and hip spica treatment options, respectively. For the range of complication probabilities considered, expected total costs were always greater with the external fixation option than with the hip spica treatment.
本研究的目的是评估小儿股骨干骨折早期髋人字石膏固定和外固定的相对卫生系统成本。从研究医院和医生的角度，使用基于当前实践的方案进行了成本分析。成本估计基于1993年4月1日至1994年1月31日的患者和财务信息，包括全额分摊的住院和门诊费用。进行了敏感性分析以分析并发症对成本的影响。单纯外固定和髋人字石膏治疗的估计总成本（以1994年加元计，1.00加元 = 0.75美元）分别为7626.30加元和5970.11加元。这种差异的50%归因于外固定治疗住院时间更长。其余差异是由于固定器成本、额外的手术室工作人员时间成本以及额外的专业和技术费用。因复位丢失、针道感染和返回手术室而复杂化的治疗的预期总成本，外固定和髋人字石膏治疗方案分别为7716.01加元和6128.44加元。对于所考虑的并发症概率范围，外固定方案的预期总成本始终高于髋人字石膏治疗。
