title: Cost-effectiveness analysis of cast versus splint in children with acceptably angulated wrist fractures.
abstract: OBJECTIVE
  In a practice setting where casting is considered the standard of care, the aim of this study was to assess the cost-effectiveness of wrist splints compared with routine casting in children with acceptably angulated distal radius greenstick or transverse fractures.
  
  
  METHODS
  A cost-effectiveness analysis was conducted alongside a randomized controlled trial (RCT). One hundred children with acceptably angulated distal radius greenstick or transverse fractures received either a wrist splint or cast. Information on health care provider and patient and family resource use as well as productivity cost was collected. Resource use was costed using unit costs from local administrative data sources and expense diaries. Effectiveness was assessed at 6 weeks using the performance version of the Activities Scale for Kids (ASKp) questionnaire. Cost-effectiveness analysis related differential costs to differential ASKp scores.
  
  
  RESULTS
  Mean total cost was $877.58 in the splint group and $950.35 in the cast group, with a mean difference of $-72.76 (standard error [SE] 45.88). Mean total healthcare cost was $670.66 in the splint group and $768.22 in the cast group, with a mean difference of $-97.56 (SE 9.24). Mean (SE) ASKp was 92.8 in the splint group and 91.4 in the cast group, with a mean difference of 1.439 (SE 1.585). Therefore, splint management was more effective and cheaper. After accounting for uncertainty, the probability of splint being cost-effective compared with cast was 94 percent for a willingness-to-pay threshold value of $0 for one-unit gain in ASKp score and exceeded 82 percent for all threshold values.
  
  
  CONCLUSIONS
  In this RCT, splint management was cost-effective compared with casting in children with acceptably angulated distal radius greenstick or transverse fractures. This study challenges the existing standard of care for children with this type of fracture and provides justification on clinical and economic grounds for a change in routine practice.
authors: Programs PATH Research Institute, St. Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, Ontario L8N 4A6, Canada. vonkeys@mcmaster.ca
authors: Camilla
authors: C
authors: von Keyserlingk
authors: Kathy
authors: K
authors: Boutis
authors: Andrew R
authors: AR
authors: Willan
authors: Robert Borden
authors: RB
authors: Hopkins
authors: Ron
authors: R
authors: Goeree
mesh_terms: D002370:Casts, Surgical / Q000191:economics*; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D005260:Female; D050723:Fractures, Bone / Q000191:economics* / Q000534:rehabilitation; D017048:Health Care Costs; D006801:Humans; D008297:Male; D009864:Ontario; D010372:Pediatrics / Q000191:economics; D013165:Splints / Q000191:economics*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014954:Wrist Injuries / Q000191:economics* / Q000534:rehabilitation