Cost effectiveness of treatment with percutaneous Kirschner wires versus volar locking plate for adult patients with a dorsally displaced fracture of the distal radius

Abstract

2 DISCLAIMERThe series enables staff and student researchers based at or affiliated with the AUHE to make recent work and work in progress available to a wider audience. The work and ideas reported here may not always represent the final position and as such may sometimes need to be treated as work in progress. The material and views expressed in the series are solely those of the authors and should not be quoted without their permission. Additional information FundingThis study was funded through the Health Technology Assessment scheme of the NIHR (HTA08/116/97). This manuscript presents independent research commissioned by the National Institute for Health Research. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. Ethical approvalThis study approved by the Coventry research ethics committee under reference number 10/H1210/10. Approval was obtained from the research and development department of UHCW NHS trust. AcknowledgementsWe thank all those involved in making DRAFFT a success, including the patients and the research associates at all the research sites and in particular Jaclyn Brown, Isabel Wall, and Susie Hennings for their input in trial coordination and management and Caroline Plant for the analysis of patients' radiographs. Cost-effectiveness of percutaneous fixation with Kirschner wires versus locking-plate for adult patients with a dorsally displaced fracture of the distal radius from the DRAFFT trial AbstractWe present the economic evaluation from the Distal Radius Acute Fracture Fixation Trial, which compared the cost-effectiveness of K-wire fixation with locking-plate fixation for patients with a dorsally-displaced fracture of the distal radius.The cost-effectiveness analysis (cost per 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 UK. Resource use data were received from 460 patients; only one patient did not provide any resource use data. The analysis includes both the Health Service perspective -cost of surgery, implants, physiotherapy etc -and the societal perspective -cost of time off work and private care.There was small difference in health-related quality of life (QALYs gain) for patients treated with locking-plate versus K-wire fixation. At an additional cost of £714, locking-plate fixation presented an incremental cost-effectiveness ratio of £89,322 per QALY within the first 12 months of treatment. A number of sensitivity analyses were undertaken, but the incremental costeffectiveness ratios of locking-plates fixation compared with K-wires were always more than £30,000.The economic evaluation is driven by the choice of fixation; K-wire fixation is a 'cost saving' intervention being substantially less expensive than locking-plate fixation.

Epidemiology and time trends of distal forearm fractures in adults - a study of 11.2 million person-years in Sweden

“…Cost-benefit analyses have revealed small or no gains measured in Quality Adjusted Life Years (QALY) comparing volar plating procedures with other treatment options [34, 35]. …”

Nonoperative Treatment Compared with Volar Locking Plate Fixation for Dorsally Displaced Distal Radial Fractures in the Elderly

“…As there are indications that VLP is not cost-effective compared with percutaneous methods [120][121][122]124 , and as health care resources are limited, there is a need to investigate regional differences in Sweden and similar countries regarding surgical treatment of DRFs.…”

“…British studies have shown that VLP treatment is not cost-effective compared with PF up to one year after treatment of a DRF 123,124 .…”

A comparison of the cost-effectiveness of intramedullary nail fixation and locking plate fixation in the treatment of adult patients with an extra-articular fracture of the distal tibia

“…As a general rule, NICE considers interventions costing the NHS less than £20,000 per QALY gained cost-effective [24] . To determine the level of sampling uncertainty around the ICER, we conducted non-parametric bootstrapping, generating 50,000 estimates of incremental costs and benefits [25] . The bootstrap replicates from the non-parametric bootstrapping were used to populate costeffectiveness scatterplots.…”