title: Cost-Effectiveness of Diagnostic Strategies for Suspected Scaphoid Fractures.
abstract: OBJECTIVE
  The aim of this study was to assess the cost effectiveness of multiple competing diagnostic strategies for suspected scaphoid fractures.
  
  
  METHODS
  With published data, the authors created a decision-tree model simulating the diagnosis of suspected scaphoid fractures. Clinical outcomes, costs, and cost effectiveness of immediate computed tomography (CT), day 3 magnetic resonance imaging (MRI), day 3 bone scan, week 2 radiographs alone, week 2 radiographs-CT, week 2 radiographs-MRI, week 2 radiographs-bone scan, and immediate MRI were evaluated. The primary clinical outcome was the detection of scaphoid fractures. The authors adopted societal perspective, including both the costs of healthcare and the cost of lost productivity. The incremental cost-effectiveness ratio (ICER), which expresses the incremental cost per incremental scaphoid fracture detected using a strategy, was calculated to compare these diagnostic strategies. Base case analysis, 1-way sensitivity analyses, and "worst case scenario" and "best case scenario" sensitivity analyses were performed.
  
  
  RESULTS
  In the base case, the average cost per scaphoid fracture detected with immediate CT was $2553. The ICER of immediate MRI and day 3 MRI compared with immediate CT was $7483 and $32,000 per scaphoid fracture detected, respectively. The ICER of week 2 radiographs-MRI was around $170,000. Day 3 bone scan, week 2 radiographs alone, week 2 radiographs-CT, and week 2 radiographs-bone scan strategy were dominated or extendedly dominated by MRI strategies. The results were generally robust in multiple sensitivity analyses.
  
  
  CONCLUSIONS
  Immediate CT and MRI were the most cost-effective strategies for diagnosing suspected scaphoid fractures.
  
  
  METHODS
  Economic and Decision Analyses Level II. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Hand Surgery, Tianjin Hospital, Tianjin, China.
authors.forename: Zhong-Gang
authors.initials: ZG
authors.lastname: Yin
authors.forename: Jian-Bing
authors.initials: JB
authors.lastname: Zhang
authors.forename: Ke-Tong
authors.initials: KT
authors.lastname: Gong
mesh_terms: D003198:Computer Simulation; D003362:Cost-Benefit Analysis / Q000191:economics / Q000379:methods; D050723:Fractures, Bone / Q000175:diagnosis* / Q000191:economics* / Q000453:epidemiology; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D038622:Internationality; D008279:Magnetic Resonance Imaging / Q000191:economics* / Q000706:statistics & numerical data; D018803:Models, Economic; D015203:Reproducibility of Results; D021361:Scaphoid Bone / Q000000981:diagnostic imaging / Q000293:injuries* / Q000473:pathology; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000191:economics* / Q000706:statistics & numerical data