Cost-effectiveness of introducing cone-beam computed tomography (CBCT) in the management of complex phalangeal fractures: economic simulation

Abstract

Purpose The purpose of this study was to evaluate the cost-effectiveness of introducing cone-beam computed tomography (CBCT) in the management of the complex finger fractures with articular involvement. Methods We created a decision tree model simulating the diagnostic pathway of complex finger fractures, suggesting the use of CBCT as alternative to multi-slice computed tomography (MSCT), and we compared their clinical outcomes, costs, and cost-effectiveness for a hypothetical cohort of 10,000 patients. Measures of effectiveness are analysed by using quality-adjusted life years, incremental cost-effectiveness ratio, and net monetary benefit. Results Diagnosis of a complex finger fracture performed with CBCT costed 67.33€ per patient, yielded 9.08 quality-adjusted life years, and gained an incremental cost-effectiveness ratio of 29.94€ and a net monetary benefit of 9.07 € at 30,000€ threshold. Using MSCT for diagnosis costed 106.23 €, yielded 8.18 quality-adjusted life years, and gained an incremental cost-effectiveness ratio of 371.15 € and a net monetary benefit of 8.09 €. CBCT strategy dominated the MSCT strategy. The acceptability curve shows that there is 98% probability of CBCT being the optimal strategy at 30,000€ threshold (1 EUR equal to 1.11 USD; updated on 02/02/2020). Conclusion CBCT in complex finger fractures management is cost saving compared with MSCT and may be considered a valuable imaging tool in preoperative assessment, allowing early detection and appropriate treatment. It shortens the time to completion of diagnostic work-up, reduces the number of additional diagnostic procedures, improves quality of life, and may reduce costs in a societal perspective.

The use of cone-beam computed tomography (CBCT) in radiocarpal fractures: a diagnostic test accuracy meta-analysis

“…CBCT produces sub-millimetre resolution ranging from 0.4 mm to as low as 0.09 mm, whilst standard CT has a spatial resolution of 1-2 mm [34]. Although, to date, no cost-benefit analysis has been performed radiocarpal fractures, Faccioli et al [35] demonstrated that the introduction of CBCT compared to MDCT in the management of complex finger fractures reduces the time of diagnostic work-up and number of diagnostic procedures, improves quality of life and reduces costs. When trialled in the emergency radiology department, CBCT offered a feasible alternative to MDCT for detection of extremity fractures also increasing patient turnover and reducing radiation exposure [36].…”

Hand and wrist – what the hand surgeon wants to know from the radiologist

“…To better visualise the fracture, a special form of computed tomography is increasingly used, such as cone-beam computed tomography (CBCT) technology. The advantages of CBCT include smaller set-ups, high spatial resolution, optimal reduction in metal artefacts, low radiation dose, and relatively low cost of the equipment compared to multi-slice computed tomography (MSCT) [ 4 ]. Confirmation of dislocation – plain radiographs could be misleading in perilunate or carpometacarpal joint dislocations, especially if physicians in the emergency room are less experienced ( Figure 1 ).…”

“…To better visualise the fracture, a special form of computed tomography is increasingly used, such as cone-beam computed tomography (CBCT) technology. The advantages of CBCT include smaller set-ups, high spatial resolution, optimal reduction in metal artefacts, low radiation dose, and relatively low cost of the equipment compared to multi-slice computed tomography (MSCT) [ 4 ].…”