title: Cost effectiveness of surgical versus non-surgical treatment of adults with displaced fractures of the proximal humerus: economic evaluation alongside the PROFHER trial.
abstract: OBJECTIVE
  A pragmatic multicentre randomised controlled trial (PROFHER) was conducted in United Kingdom National Health Service (NHS) hospitals to evaluate the clinical effectiveness and cost effectiveness of surgery compared with non-surgical treatment for displaced fractures of the proximal humerus involving the surgical neck in adults.
  
  
  METHODS
  A cost utility analysis from the NHS perspective was performed. Differences between surgical and non-surgical treatment groups in costs and quality adjusted life years (QALYs) at two years were used to derive an estimate of the cost effectiveness of surgery using regression methods.
  
  
  RESULTS
  Patients randomised to receive surgical intervention accumulated mean greater costs and marginally lower QALYs than patients randomised to non-surgery. The surgical intervention cost a mean of £1758 more per patient (95% confidence intervals (CI) £1126 to £2389). Total QALYs for the surgical group were smaller than those for non-surgery -0.0101 (95% CI -0.13 to 0.11). The probability of surgery being cost effective was less than 10% given the current NICE willingness to pay at a threshold of £20 000 for an additional QALY. The results were robust to sensitivity analyses.
  
  
  CONCLUSIONS
  The results suggest that current surgical treatment is not cost effective for the majority of displaced fractures of the proximal humerus involving the surgical neck in the United Kingdom's NHS.
  
  
  CONCLUSIONS
  The results of this trial do not support the trend of increased surgical treatment for patients with displaced fractures of the proximal humerus involving the surgical neck within the United Kingdom NHS.
authors: University of York, Heslington, York, YO10 5DD, UK.
authors: B
authors: B
authors: Corbacho
authors: Centre for Health Economics, University of York, Alcuin Block A, University of York, York, YO10 5DD, UK.
authors: A
authors: A
authors: Duarte
authors: University of York, Heslington, York, YO10 5DD, UK.
authors: A
authors: A
authors: Keding
authors: Teesside University, Middlesbrough, Tees Valley, TS1 3BA, UK.
authors: H
authors: H
authors: Handoll
authors: Pharmerit Europe, Marten Meesweg 107, 3068 AV Rotterdam, The Netherlands.
authors: L H
authors: LH
authors: Chuang
authors: University of York, Heslington, York, YO10 5DD, UK.
authors: D
authors: D
authors: Torgerson
authors: University of York, Heslington, York, YO10 5DD, UK.
authors: S
authors: S
authors: Brealey
authors: University of York, Heslington, York, YO10 5DD, UK.
authors: L
authors: L
authors: Jefferson
authors: University of York, Heslington, York, YO10 5DD, UK.
authors: C
authors: C
authors: Hewitt
authors: James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK.
authors: A
authors: A
authors: Rangan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D005260:Female; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D019736:Prostheses and Implants / Q000191:economics; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012784:Shoulder Fractures / Q000191:economics* / Q000628:therapy; D013222:State Medicine / Q000191:economics; D016896:Treatment Outcome; D055815:Young Adult
keywords: Cost-effectiveness analysis; displaced fractures of the proximal humerus; surgical treatment; within-trial economic evaluation