A cost/utility analysis of open reduction and internal fixation versus cast immobilization for acute nondisplaced mid-waist scaphoid fractures.
BACKGROUND
Open reduction and internal fixation and cast immobilization are both acceptable treatment options for nondisplaced waist fractures of the scaphoid. The authors conducted a cost/utility analysis to weigh open reduction and internal fixation against cast immobilization in the treatment of acute nondisplaced mid-waist scaphoid fractures.


METHODS
The authors used a decision-analytic model to calculate the outcomes and costs of open reduction and internal fixation and cast immobilization, assuming the societal perspective. Utilities were assessed from 50 randomly selected medical students using the time trade-off method. Outcome probabilities taken from the literature were factored into the calculation of quality-adjusted life-years associated with each treatment. The authors estimated medical costs using Medicare reimbursement rates, and costs of lost productivity were estimated by average wages obtained from the U.S. Bureau of Labor Statistics.


RESULTS
Open reduction and internal fixation offers greater quality-adjusted life-years compared with casting, with an increase ranging from 0.21 quality-adjusted life-years for the 25- to 34-year age group to 0.04 quality-adjusted life-years for the > or =65-year age group. Open reduction and internal fixation is less costly than casting ($7940 versus $13,851 per patient) because of a longer period of lost productivity with casting. Open reduction and internal fixation is therefore the dominant strategy. When considering only direct costs, the incremental cost/utility ratio for open reduction and internal fixation ranges from $5438 per quality-adjusted life-year for the 25- to 34-year age group to $11,420 for the 55- to 64-year age group, and $29,850 for the > or =65-year age group.


CONCLUSIONS
Compared with casting, open reduction and internal fixation is cost saving from the societal perspective ($5911 less per patient). When considering only direct costs, open reduction and internal fixation is cost-effective relative to other widely accepted interventions.
Department of Surgery, Veterans Affairs Medical Center, University of Michigan Medical School, Ann Arbor, Michigan, USA.
Erika N
EN
Davis
Kevin C
KC
Chung
Sandra V
SV
Kotsis
Frank H
FH
Lau
Sandeep
S
Vijan
D000328:Adult; D000368:Aged; D002370:Casts, Surgical / Q000191:economics*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000191:economics*; D050723:Fractures, Bone / Q000191:economics*; D017048:Health Care Costs; D006801:Humans; D007103:Immobilization; D008824:Michigan; D008875:Middle Aged; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D021361:Scaphoid Bone / Q000293:injuries*