title: Functional outcome and cost-effectiveness of pulsed electromagnetic fields in the treatment of acute scaphoid fractures: a cost-utility analysis.
abstract: BACKGROUND
  Physical forces have been widely used to stimulate bone growth in fracture repair. Addition of bone growth stimulation to the conservative treatment regime is more costly than standard health care. However, it might lead to cost-savings due to a reduction of the total amount of working days lost. This economic evaluation was performed to assess the cost-effectiveness of Pulsed Electromagnetic Fields (PEMF) compared to standard health care in the treatment of acute scaphoid fractures.
  
  
  METHODS
  An economic evaluation was carried out from a societal perspective, alongside a double-blind, randomized, placebo-controlled, multicenter trial involving five centres in The Netherlands. One hundred and two patients with a clinically and radiographically proven fracture of the scaphoid were included in the study and randomly allocated to either active bone growth stimulation or standard health care, using a placebo. All costs (medical costs and costs due to productivity loss) were measured during one year follow up. Functional outcome and general health related quality of life were assessed by the EuroQol-5D and PRWHE (patient rated wrist and hand evaluation) questionnaires. Utility scores were derived from the EuroQol-5D.
  
  
  RESULTS
  The average total number of working days lost was lower in the active PEMF group (9.82 days) compared to the placebo group (12.91 days) (p = 0.651). Total medical costs of the intervention group (€1594) were significantly higher compared to the standard health care (€875). The total amount of mean QALY's (quality-adjusted life year) for the active PEMF group was 0.84 and 0.85 for the control group. The cost-effectiveness plane shows that the majority of all cost-effectiveness ratios fall into the quadrant where PEMF is not only less effective in terms of QALY's but also more costly.
  
  
  CONCLUSIONS
  This study demonstrates that the desired effects in terms of cost-effectiveness are not met. When comparing the effects of PEMF to standard health care in terms of QALY's, PEMF cannot be considered a cost-effective treatment for acute fractures of the scaphoid bone.
  
  
  BACKGROUND
  Netherlands Trial Register (NTR): NTR2064.
authors.affiliation: Department of Surgery and Traumasurgery, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands. pfwhannemann@gmail.com.
authors.forename: Pascal F W
authors.initials: PF
authors.lastname: Hannemann
authors.affiliation: Department of Clinical Epidemiology & Medical Technology Assessement (CEMTA), Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands. brigitte.essers@mumc.nl.
authors.forename: Brigitte A B
authors.initials: BA
authors.lastname: Essers
authors.affiliation: Department of Surgery and Traumasurgery, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands. judith.schots@gmail.com.
authors.forename: Judith P M
authors.initials: JP
authors.lastname: Schots
authors.affiliation: Department of Surgery and Traumasurgery, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands. koendullaert@gmail.com.
authors.forename: Koen
authors.initials: K
authors.lastname: Dullaert
authors.affiliation: Department of Surgery and Traumasurgery, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands. m.poeze@mumc.nl.
authors.forename: Martijn
authors.initials: M
authors.lastname: Poeze
authors.affiliation: Department of Surgery and Traumasurgery, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands. p.brink@mumc.nl.
authors.forename: Peter R G
authors.initials: PR
authors.lastname: Brink
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D004311:Double-Blind Method; D004574:Electromagnetic Fields; D005260:Female; D050723:Fractures, Bone / Q000191:economics* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D019057:Quality-Adjusted Life Years; D021361:Scaphoid Bone / Q000293:injuries*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult