A cost-utility analysis of amputation versus salvage for Gustilo type IIIB and IIIC open tibial fractures.
BACKGROUND
Lower extremity trauma is common. Despite an abundance of literature on severe injuries that can be treated with salvage or amputation, the appropriate management of these injuries remains uncertain. In this situation, a cost-utility analysis is an important tool in providing an evidence-based practice approach to guide treatment decisions.


METHODS
Costs following amputation and salvage were derived from data presented in a study that emerged from the Lower Extremity Assessment Project. The authors extracted relevant data on projected lifetime costs and analyzed them to include discounting and sensitivity analysis by considering patient age. The utilities for the various health states (amputation or salvage, including possible complications) were measured previously using the standard gamble method and a decision tree simulation to determine quality-adjusted life-years.


RESULTS
Amputation is more expensive than salvage, independently of varied ongoing prosthesis needs, discount rate, and patient age at presentation. Moreover, amputation yields fewer quality-adjusted life-years than salvage. Salvage is deemed the dominant, cost-saving strategy.


CONCLUSIONS
Unless the injury is so severe that salvage is not a possibility, based on this economic model, surgeons should consider limb salvage, which will yield lower costs and higher utility when compared with amputation.
Chung
Kevin C
KC
Ann Arbor, Mich. From the Section of Plastic Surgery, Department of Surgery, University of Michigan Health System; the University of Michigan Medical School; and the University of Michigan's Stephen M. Ross School of Business.
Saddawi-Konefka
Daniel
D
Haase
Steven C
SC
Kaul
Gautam
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D000671:Amputation, Surgical / Q000191:economics* / Q000379:methods; D003362:Cost-Benefit Analysis; D005260:Female; D005597:Fractures, Open / Q000191:economics / Q000601:surgery*; D017048:Health Care Costs; D006801:Humans; D015601:Injury Severity Score; D008017:Life Expectancy; D023821:Limb Salvage / Q000191:economics* / Q000379:methods; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D012680:Sensitivity and Specificity; D013978:Tibial Fractures / Q000175:diagnosis / Q000191:economics / Q000601:surgery*; D014481:United States; D055815:Young Adult