Cost-effectiveness of volar locking plate versus percutaneous fixation for distal radial fractures: Economic evaluation alongside a randomised clinical trial.
This study compares the cost-effectiveness of treating dorsally displaced distal radial fractures with a volar locking plate and percutaneous fixation. It was performed from the perspective of the National Health Service (NHS) using data from a single-centre randomised controlled trial. In total 130 patients (18 to 73 years of age) with a dorsally displaced distal radial fracture were randomised to treatment with either a volar locking plate (n = 66) or percutaneous fixation (n = 64). The methodology was according to National Institute for Health and Care Excellence guidance for technology appraisals. . There were no significant differences in quality of life scores between groups at any time point in the study. Both groups returned to baseline one year post-operatively. NHS costs for the plate group were significantly higher (p < 0.001, 95% confidence interval 497 to 930). For an additional £713, fixation with a volar locking plate offered 0.0178 additional quality-adjusted life years in the year after surgery. The incremental cost-effectiveness ratio (ICER) for plate fixation relative to percutaneous fixation at list price was £40 068. When adjusting the prices of the implants for a 20% hospital discount, the ICER was £31 898. Patients who underwent plate fixation did not return to work earlier. We found no evidence to support the cost-effectiveness, from the perspective of the NHS, of fixation using a volar locking plate over percutaneous fixation for the operative treatment of a dorsally displaced radial fracture.
Academic Orthopaedics, Trauma and Sports Medicine, Arthritis Research UK Pain and Sports, Exercise and Osteoarthritis Centres, School of MedicineUniversity of Nottingham and Nottingham University Hospitals NHS Trust.
A
A
Karantana
Academic Orthopaedics, Trauma and Sports Medicine, Arthritis Research UK Pain and Sports, Exercise and Osteoarthritis Centres, School of MedicineUniversity of Nottingham and Nottingham University Hospitals NHS Trust.
B E
BE
Scammell
Nottingham University Hospitals NHS Trust, C Floor, West Block, Queen's Medical Centre, Nottingham NG7 2UH, UK.
T R C
TR
Davis
University of Nottingham, School of Economics, University Park, Nottingham NG7 2RD, UK.
D K
DK
Whynes
D000293:Adolescent; D000328:Adult; D000368:Aged; D001860:Bone Plates / Q000191:economics*; D003362:Cost-Benefit Analysis; D004739:England; D005260:Female; D005593:Fracture Fixation, Internal / Q000191:economics* / Q000295:instrumentation / Q000379:methods; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D011885:Radius Fractures / Q000191:economics / Q000601:surgery*; D013222:State Medicine / Q000191:economics; D055815:Young Adult
Distal radial fracture; cost-effectiveness; percutaneous fixation; randomised trial; volar locking plate