Heckman J D, Sarasohn-Kahn J
Department of Orthopaedics, University of San Antonio Health Science Center, Texas, USA.
Bull Hosp Jt Dis. 1997;56(1):63-72.
The tibia, being the most commonly fractured long bone, is associated with a high incidence of delayed union and non-union. A previously published prospective, randomized, double-blind and placebo-controlled tibia study demonstrated that pulsed, low-intensity ultrasound shortened the time to a healed fracture and significantly reduced the incidence of delayed union. The economics of treating tibia fractures has never been calculated. We have reviewed the literature pertaining to the tibia, the results of the above published tibia study, and stratified the data from that study for those patient and fracture co-morbidity factors that can influence healing of tibia fractures. Three economic models are presented with the total costs of treating a pool of 1,000 patients with tibial shaft fractures divided into two treatment paths--operative and conservative. These costs include surgery and recovery, outpatient costs, and Workers' Compensation costs for both the primary and secondary procedures, and emergency room and disability costs. The first model does not use low-intensity ultrasound and provides a summary of the costs associated with fracture treatment for each treatment path. The second model uses low-intensity ultrasound adjunctively with the conservatively treated group while the third model uses ultrasound adjunctively in both the operative and conservative groups. When comparing the conservative treatment path of Model 2 to Model 1 a cost savings of over $15,000 per case (40%) is realized by dramatically lowering secondary procedures and Workers' Compensation costs when pulsed low-intensity ultrasound is used adjunctively with conservative treatment. A similar savings of over $13,000 per case results from the use of ultrasound in the operative treatment path of Model 3 when compared with the standard operative care of Model 1. The total savings realized is over $14.6 million when adjunctively using low-intensity ultrasound in both the conservative and operative treatment paths. These analyses demonstrate that reduced healing time could yield substantial cost savings for third party payors, employers, and government agencies by lessening the need for secondary procedures and reducing the amount of Workers' Compensation payments.
胫骨是最常发生骨折的长骨，延迟愈合和不愈合的发生率很高。之前发表的一项关于胫骨的前瞻性、随机、双盲和安慰剂对照研究表明，脉冲式低强度超声缩短了骨折愈合时间，并显著降低了延迟愈合的发生率。治疗胫骨骨折的经济学成本从未被计算过。我们回顾了与胫骨相关的文献、上述已发表的胫骨研究结果，并根据可能影响胫骨骨折愈合的患者和骨折合并症因素对该研究的数据进行了分层。提出了三种经济模型，将1000例胫骨干骨折患者的治疗总成本分为手术和保守两种治疗途径。这些成本包括手术和康复、门诊费用以及初次和二次手术的工伤赔偿费用，还有急诊室和残疾费用。第一个模型不使用低强度超声，总结了每种治疗途径与骨折治疗相关的成本。第二个模型在保守治疗组中辅助使用低强度超声，而第三个模型在手术组和保守组中均辅助使用超声。将模型2的保守治疗途径与模型1进行比较时，当脉冲式低强度超声与保守治疗联合使用时，通过大幅降低二次手术和工伤赔偿成本，每例可节省超过15000美元（40%）。与模型1的标准手术治疗相比，模型3在手术治疗途径中使用超声时，每例也可节省超过13000美元。在保守和手术治疗途径中都辅助使用低强度超声时，总共可节省超过1460万美元。这些分析表明，缩短愈合时间可以通过减少二次手术的需求和降低工伤赔偿支付金额，为第三方支付方、雇主和政府机构节省大量成本。
