title: Cost effectiveness of treatment with percutaneous Kirschner wires versus volar locking plate for adult patients with a dorsally displaced fracture of the distal radius: analysis from the DRAFFT trial.
abstract: We present an economic evaluation using data from the Distal Radius Acute Fracture Fixation Trial (DRAFFT) to compare the relative cost effectiveness of percutaneous Kirschner wire (K-wire) fixation and volar locking-plate fixation for patients with dorsally-displaced fractures of the distal radius. The cost effectiveness analysis (cost per quality-adjusted life year; QALY) was derived from a multi-centre, two-arm, parallel group, assessor-blind, randomised controlled trial which took place in 18 trauma centres in the United Kingdom. Data from 460 patients were available for analysis, which includes both a National Health Service cost perspective including costs of surgery, implants and healthcare resource use over a 12-month period after surgery, and a societal perspective, which includes the cost of time off work and the need for additional private care. There was only a small difference in QALYs gained for patients treated with locking-plate fixation over those treated with K-wires. At a mean additional cost of £714 (95% confidence interval 588 to 865) per patient, locking-plate fixation presented an incremental cost effectiveness ratio (ICER) of £89,322 per QALY within the first 12 months of treatment. Sensitivity analyses were undertaken to assess the ICER of locking-plate fixation compared with K-wires. These were greater than £30,000. Compared with locking-plate fixation, K-wire fixation is a 'cost saving' intervention, with similar health benefits.
authors.affiliation: University of Leeds, 101 Clarendon Road, Leeds LS6 9LJ, UK.
authors.forename: S
authors.initials: S
authors.lastname: Tubeuf
authors.affiliation: University of Leeds, 101 Clarendon Road, Leeds LS6 9LJ, UK.
authors.forename: G
authors.initials: G
authors.lastname: Yu
authors.affiliation: University of Oxford John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.
authors.forename: J
authors.initials: J
authors.lastname: Achten
authors.affiliation: University of Warwick, Gibbet Hill Road, Coventry CV4 7AL, UK.
authors.forename: N R
authors.initials: NR
authors.lastname: Parsons
authors.affiliation: The James Cook University Hospital, Marton Road, Middlesbrough TS4 3BW, UK.
authors.forename: A
authors.initials: A
authors.lastname: Rangan
authors.affiliation: University of Oxford, Windmill Road, Headington Oxford, OX3 7LD, UK.
authors.forename: S E
authors.initials: SE
authors.lastname: Lamb
authors.affiliation: University of Oxford John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.
authors.forename: M L
authors.initials: ML
authors.lastname: Costa
mesh_terms: D001860:Bone Plates; D001864:Bone Wires; D003362:Cost-Benefit Analysis; D005260:Female; D005593:Fracture Fixation, Internal / Q000191:economics* / Q000295:instrumentation*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D053401:Palmar Plate / Q000601:surgery*; D019057:Quality-Adjusted Life Years; D011885:Radius Fractures / Q000601:surgery*; D013222:State Medicine
keywords: economic evaluation; QALY; within-trial; K-wire; distal radius fracture; volar locking-plate