Cost-utility analysis of extensile lateral approach versus sinus tarsi approach in Sanders type II/III calcaneus fractures

Abstract

Background Extensile lateral approach had been recognized as the gold standard technique for displaced intra-articular calcaneus fractures (DIACFs) while sinus tarsi approach had been increasingly valued by surgeons and comparative clinical outcome was shown in both techniques. Appropriate decisions could be made by the clinicians with the help of cost-utility analysis (CUA) about optimal healthcare for type II/III calcaneus fracture. Method A single-center, retrospective study was conducted in which basic characteristics, clinical outcomes, and health care costs of 109 patients had been obtained and analyzed. Changes in health-related quality of life (HRQoL) scores, validated by EuroQol five-dimensional-three levels (EQ-5D-3L), were used to enumerate quality-adjusted life years (QALYs). Cost-effectiveness was determined by the incremental cost per QALY. Results One hundred nine patients were enrolled in our study including 62 in the ELA group and 47 in the STA group. There were no significant differences between these two groups in mean total cost, laboratory, and radiographic evaluation expense, surgery, anesthesia, and antibiotic expense. The expense of internal fixation materials ($3289.0 ± 543.9) versus ($2630.6 ± 763.7) and analgesia ($145.8 ± 85.6) versus ($102.9 ± 62.7) in ELA group were significantly higher than in the STA group (P < .001, P = .008, respectively). Visual Analogue Scale (VAS) scores showed significant difference at postoperative 3 and 5 days (P < .001). American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores and the Bohlers’ and Gissane angle showed no significant differences between the two groups before and after the operation. The cost-effectiveness ratios of ELA and STA were $8766.8 ± 2835.2/QALY and $7914.9 ± 1822.0/QALY respectively, and incremental cost-effectiveness ratio (ICERs) of ELA over STA was $32110.00/QALY, but both showed no significant difference. Conclusion Both ELA and STA techniques are effective operative procedures for the patients with calcaneus fracture. Moreover, STA seems to be more reasonable for its merits including less postoperative pain, and less expense of analgesia as well as internal fixation materials. Level of evidence 5

Are the non-weight bearing guidelines for the after treatment of calcaneal fractures still decisive? A Dutch survey among orthopaedic and trauma surgeons

“…A recent systematic review concluded that STA may be the preferred approach in the operative treatment of patients with displaced Sanders type II and III DIACFs in order to reduce wound healing complications, time-to-surgery and operative time and shows a similar restoration of calcaneal anatomy [ 15 ]. Although better clinical outcomes favoring STA seem to be achieved, recent literature showed no significant difference in the cost-effectiveness of ELA versus STA (ELA $8766.8 ± 2835.2/QALY, STA $7914.9 ± 1822.0/QALY respectively) [ 22 ].…”

Economic evaluations in fracture research an introduction with examples of foot fractures

“…Five studies could be considered appropriate (full) economic evaluations regarding patients with traumatic foot fractures. These were the studies by Brauer et al [23] , Albright et al [24] , Li et al [25] , Clement et al [26] , and Albin et al [27] . The most relevant characteristics can be found summarized in Table 1 (See Table 1 ).…”

“…Li et al mainly encountered problems relating to the smaller sample size and the possible single centre bias. Next to this, only the healthcare costs were included [25] . Clement et al use the societal perspective which is the best possible option, however this also limited impact of the study, since the societal costs (e.g.…”

“…However, no prospective data on costs was collected in this trial [23] . The first trial-based study had a relatively small sample size and was open to single centre bias [25] . The studies with a societal perspective faced issues with the measurement of societal costs [ 23 , 26 , 27 ].…”