Surgical treatment is not cost-effective compared to nonoperative treatment for displaced distal radius fractures in patients 65 years and over

Abstract

Aims The purpose was to compare operative treatment with a volar plate and nonoperative treatment of displaced distal radius fractures in patients aged 65 years and over in a cost-effectiveness analysis. Methods A cost-utility analysis was performed alongside a randomized controlled trial. A total of 50 patients were randomized to each group. We prospectively collected data on resource use during the first year post-fracture, and estimated costs of initial treatment, further operations, physiotherapy, home nursing, and production loss. Health-related quality of life was based on the Euro-QoL five-dimension, five-level (EQ-5D-5L) utility index, and quality-adjusted life-years (QALYs) were calculated. Results The mean QALYs were 0.05 higher in the operative group during the first 12 months (p = 0.260). The healthcare provider costs were €1,533 higher per patient in the operative group: €3,589 in the operative group and 2,056 in the nonoperative group. With a suggested willingness to pay of €27,500 per QALY there was a 45% chance for operative treatment to be cost-effective. For both groups, the main costs were related to the primary treatment. The primary surgery was the main driver of the difference between the groups. The costs related to loss of production were high in both groups, despite high rates of retirement. Retirement rate was unevenly distributed between the groups and was not included in the analysis. Conclusion Surgical treatment was not cost-effective in patients aged 65 years and older compared to nonoperative treatment of displaced distal radius fractures in a healthcare perspective. Costs related to loss of production might change this in the future if the retirement age increases. Level of evidence: II Cite this article: Bone Jt Open 2021;2(12):1027–1034.

A Cost-Effectiveness Analysis of the Various Treatment Options for Distal Radius Fractures

“…Other studies have reached varying conclusions on the relative cost effectiveness of treatment options for DRFs. In a randomized study of patients aged 65 years and older with displaced DRFs, Hassellund et al 24 found that volar plating was not cost effective compared with nonsurgical treatment from the health care perspective despite significantly higher health-related quality of life associated with surgical treatment. In a randomized study of patients aged 50–74 years with unstable dorsally displaced fractures, Saving et al 25 found that volar plating resulted in higher costs and a smaller quality of life benefit compared with external fixation.…”

“…All transition-state probabilities and ranges can be seen in Table 1 . 3 , 5 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , …”

A comparison of the functional results and costs of functional cast and volar-flexion ulnar deviation cast at 2-year follow-up in 105 patients aged 65 and older with dorsally displaced distal radius fracture: A randomized controlled trial

“…With a willingness to pay €27 500 per QALY, there was a 45% chance of the operative treatment being effective. The authors concluded that operative treatment was not cost-effective from a healthcare perspective, Hassellund et al [ 27 ]. The cost effectiveness of different operative treatment options in the older population have also been studied.…”

Økonomisk evaluering av helsetiltak – en strukturert gjennomgang av studier gjennomført i Norge

“…I 2021 ble det fremmet et ønske om at prioriteringsforskriften også skulle omfatte primaerhelsetjenesten (Meld. St. 38 (2020-2021), men det er fortsatt ikke utarbeidet en forskrift.…”