Nationwide cost-effectiveness analysis of surgical stabilization of rib fractures by flail chest status and age groups

Abstract

BACKGROUND Surgical stabilization of rib fracture (SSRF) is increasingly used to manage patients with rib fractures. Benefits of performing SSRF appear variable, and the procedure is costly, necessitating cost-effectiveness analysis for distinct subgroups. We aimed to assess the cost-effectiveness of SSRF versus nonoperative management among patients with rib fractures younger than 65 years versus 65 years or older, with versus without flail chest. We hypothesized that, compared with nonoperative management, SSRF is cost-effective only for patients with flail chest. METHODS This economic evaluation used a decision-analytic Markov model with a lifetime time horizon incorporating US population-representative inputs to simulate benefits and risks of SSRF compared with nonoperative management. We report quality-adjusted life years (QALYs), costs, and incremental cost-effectiveness ratios. Deterministic and probabilistic sensitivity analyses accounted for most plausible clinical scenarios. RESULTS Compared with nonoperative management, SSRF was cost-effective for patients with flail chest at willingness-to-pay threshold of US $150,000/QALY gained. Surgical stabilization of rib fracture costs US $25,338 and US $123,377/QALY gained for those with flail chest younger than 65 years and 65 years or older, respectively. Surgical stabilization of rib fracture was not cost-effective for patients without flail chest, costing US $172,704 and US $243,758/QALY gained for those younger than 65 years and 65 years or older, respectively. One-way sensitivity analyses showed that, under most plausible scenarios, SSRF remained cost-effective for subgroups with flail chest, and nonoperative management remained cost-effective for patients older than 65 years without flail chest. Probability that SSRF is cost-effective ranged from 98% among patients younger than 65 years with flail chest to 35% among patients 65 years or older without flail chest. CONCLUSIONS Surgical stabilization of rib fracture is cost-effective for patients with flail chest. Surgical stabilization of rib fracture may be cost-effective in some patients without flail chest, but delineating these patients requires further study. LEVEL OF EVIDENCE Economic/decision, level II.

Surgical fixation of rib fractures improves 30-day survival after significant chest injury

“…However, both authors used models that assumed a reduction in CrCLoS, in contrast to the findings of our study. Choi et al 28 did not find rib fixation was cost-effective for the older patient aged over 65 years, or those without a flail segment, with a modelled cost of between $123,377 and $243,758 per QALY.…”

“…23,27 Uncertainty remains concerning the cost-effectiveness of offering rib fixation to a wider population of rib fracture patients. choi et al 28 and swart et al 29 have both performed modelling studies concluding that the intervention was cost-effective for younger patients with a flail chest. For patients aged under 65 years with a flail segment, the modelled incremental cost-effectiveness ratio was between $8,577 and $25,338 per quality-adjusted life year (QALY) gained.…”

Acupuncture Analgesia in Patients With Traumatic Rib Fractures: A Randomized-Controlled Trial

“…Surgery with internal fixation for rib fracture is another effective option for relieving pain, particularly in patients with severe pain and flail chest ( 6 ). However, surgical stabilization of rib fracture is costly and may not be cost-effective for patients without flail chest ( 7 ). Currently, the optimal analgesic modality remains unknown in adults with blunt thoracic trauma including traumatic rib fracture ( 3 ).…”

The Surgical Timing and Complications of Rib Fixation for Rib Fractures in Geriatric Patients

“…Although some investigations demonstrated improvement in mortality and pneumonia rates after RF fixation [ 7 , 8 ], these data were from relatively small case numbers and did not analyze the outcomes of the senior population specifically. With the development of plating systems for RF fixation and chest wall stabilization, the practice paradigm for RF management is shifting, and operative intervention is available at present [ 11 ]. Unlike young adults, geriatric patients with chronic disorders elevated the surgical risk to decrease the benefit of RF fixation [ 2 , 11 , 12 ].…”

“…With the development of plating systems for RF fixation and chest wall stabilization, the practice paradigm for RF management is shifting, and operative intervention is available at present [ 11 ]. Unlike young adults, geriatric patients with chronic disorders elevated the surgical risk to decrease the benefit of RF fixation [ 2 , 11 , 12 ]. Furthermore, the absolute surgical timing [ 13 , 14 , 15 ] and selection criteria [ 6 , 15 , 16 , 17 ] for this procedure remained uncertain.…”