Treatments, cost and healthcare utilization of patients with segmental bone defects

Norris, Brent; Vanderkarr, M.; Sparks, C.; Chitnis, A.S.; Ray, B.; Holy, Chantal E.

doi:10.1016/j.injury.2021.01.016

Cited by 19 publications

(16 citation statements)

References 20 publications

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“…The complexity of managing large bone defects is welldescribed in the literature, as well as the various methods of treatment [2,3], and their results. [30][31][32] However, evidence on the health economic aspect of their effective management is extremely scarce [33]. Theoretically, a complete health economic analysis includes direct, indirect, and intangible costs [4], whereas a cost effectiveness study should address both the societal and the health-care payer perspectives evaluating all relevant costs and benefits to the patient over their lifetime [34,35].…”

Section: Discussionmentioning

confidence: 99%

“…Theoretically, a complete health economic analysis includes direct, indirect, and intangible costs [4], whereas a cost effectiveness study should address both the societal and the health-care payer perspectives evaluating all relevant costs and benefits to the patient over their lifetime [34,35]. Recently, Norris et al [33] published a database analysis utilizing two different US-based sources including 904 patients with either the diagnosis of fracture/nonunion/ osteomyelitis, treated with bone graft, cement spacer, or a frame fixator. Payer costs were analysed from the index admission to 12 months postoperatively.…”

Section: Discussionmentioning

confidence: 99%

“…Limb reconstruction procedures (ILF and MIF) are considered discrete episodes of care, associated with high upfront costs [33]. With this pilot cost analysis, we aimed to explore the differences of direct medical costs of the two main methods of managing acute or nonunion tibial defects in the best-case scenario of a successful union.…”

Section: Discussionmentioning

confidence: 99%

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Treatment of tibial bone defects: pilot analysis of direct medical costs between distraction osteogenesis with an Ilizarov frame and the Masquelet technique

Kanakaris

Harwood

Mújica-Mota

et al. 2022

Eur J Trauma Emerg Surg

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Purpose The cost implications of limb reconstruction techniques have not been adequately investigated. Aim of this pilot study was to compare the direct medical cost of tibial bone defects managed with distraction osteogenesis–Ilizarov method (ILF), or with Masquelet technique (MIF). Methods Data of 20 random patients treated in a single centre were analysed. Inclusion criteria included acute tibial defects, or post-debridement of nonunions with complete follow-up and successful union. The endpoint of clinical efficacy was the time-to-defect union. Comparisons were made between equally sized subgroups (ILF vs. MIF). Results The average defect length was 5.6 cm (2.6–9.6 cm). The overall cost of 20 cases reached £452,974 (mean £22,339, range £13,459–£36,274). Statistically significant differences favoring the MIF were found regarding the average time-to-union; number of surgeries, of admissions and follow-up visits, as well as the mean intraoperative cost (£8857 vs. £14,087). These differences lead to significant differences of the mean cost of the overall treatment (MIF £18,131 vs. ILF £26,126). Power analysis based on these data indicated that 35 patients on each group would allow detection of a 25% difference, with an alpha value of 0.05 and probability (power) of 0.9. Conclusions The results and analysis presented highlight factors affecting the high financial burden, even in a best-case scenario, this type of surgery entails. Larger pivotal studies should follow to improve the cost efficiency of clinical practice.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Treatment of tibial bone defects: pilot analysis of direct medical costs between distraction osteogenesis with an Ilizarov frame and the Masquelet technique

Kanakaris

Harwood

Mújica-Mota

et al. 2022

Eur J Trauma Emerg Surg

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“…These types of bone defects occur in a number of settings, including acute trauma, fracture nonunion, osteomyelitis, neoplasia, spine pseudarthrosis, and revision total joint arthroplasty [ 3 ]. The associated healthcare costs for segmental bone defects are estimated as high as $300,000 per case, with significant associated patient morbidity [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

3D-Printing for Critical Sized Bone Defects: Current Concepts and Future Directions

et al. 2022

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The management and definitive treatment of segmental bone defects in the setting of acute trauma, fracture non-union, revision joint arthroplasty, and tumor surgery are challenging clinical problems with no consistently satisfactory solution. Orthopaedic surgeons are developing novel strategies to treat these problems, including three-dimensional (3D) printing combined with growth factors and/or cells. This article reviews the current strategies for management of segmental bone loss in orthopaedic surgery, including graft selection, bone graft substitutes, and operative techniques. Furthermore, we highlight 3D printing as a technology that may serve a major role in the management of segmental defects. The optimization of a 3D-printed scaffold design through printing technique, material selection, and scaffold geometry, as well as biologic additives to enhance bone regeneration and incorporation could change the treatment paradigm for these difficult bone repair problems.

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“…are unable to heal by themselves [1]. Thus, their reconstruction remains a challenge for clinicians and has a high economical and societal cost [2]. Currently, autologous bone graft is the gold standard solution to treat such defects, but it is associated with some drawbacks such as limited availability, increase in the number of surgeries required, significant postoperative donor-site morbidity, and inconsistency of repair in large bone defects exceeding typically about 5 cm 3 [3,4].…”

Section: Introductionmentioning

confidence: 99%

3D-printed polymeric scaffolds with optimized architecture to repair a sheep metatarsal critical-size bone defect

Garot

Schoffit

Monfoulet

et al. 2022

Preprint

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The reconstruction of critical-size bone defects in long bones remains a challenge for clinicians. We developed a new bioactive medical device for long bone repair by combining a 3D-printed architectured cylindrical scaffold made of clinical-grade polylactic acid (PLA) with a polyelectrolyte film coating delivering the osteogenic bone morphogenetic protein 2 (BMP-2). This film-coated scaffold was used to repair a sheep metatarsal 25-mm long critical-size bone defect. In vitro and in vivo biocompatibility of the film-coated PLA material were proved according to ISO standards. Scaffold geometry was found to influence BMP-2 incorporation. Bone regeneration was followed using X-ray scans, microCT scans, and histology . We showed that scaffold internal geometry, notably pore shape, influenced bone regeneration, which was homogenous longitudinally. Scaffolds with cubic pores of about 870 micrometers and a low BMP-2 dose of about 120 microg/cm3 induced the best bone regeneration without any adverse effects. The visual score given by clinicians during animal follow-up was found to be an easy way to predict bone regeneration. This work opens perspectives for a clinical application in personalized bone regeneration.

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Treatments, cost and healthcare utilization of patients with segmental bone defects

Cited by 19 publications

References 20 publications

Treatment of tibial bone defects: pilot analysis of direct medical costs between distraction osteogenesis with an Ilizarov frame and the Masquelet technique

Treatment of tibial bone defects: pilot analysis of direct medical costs between distraction osteogenesis with an Ilizarov frame and the Masquelet technique

3D-Printing for Critical Sized Bone Defects: Current Concepts and Future Directions

3D-printed polymeric scaffolds with optimized architecture to repair a sheep metatarsal critical-size bone defect

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