Cost-utility analysis of cast compared to removable brace in the management of adult patients with ankle fractures

Abstract

Aims To compare the cost-utility of removable brace compared with cast in the management of adult patients with ankle fracture. Methods A within-trial economic evaluation conducted from the UK NHS and personnel social services (PSS) perspective. Health resources and quality-of-life data were collected as part of the Ankle Injury Rehabilitation (AIR) multicentre, randomized controlled trial over a 12-month period using trial case report forms and patient-completed questionnaires. Cost-utility analysis was estimated in terms of the incremental cost per quality adjusted life year (QALY) gained. Estimate uncertainty was explored by bootstrapping, visualized on the incremental cost-effectiveness ratio plane. Net monetary benefit and probability of cost-effectiveness were evaluated at a range of willingness-to-pay thresholds and visualized graphically. Results The incremental cost and QALYs of using brace over a 12-month period were £46.73 (95% confidence interval (CI) £-9 to £147) and 0.0141 (95% CI -0.005 to 0.033), respectively. The cost per QALY gained was £3,318. The probability of brace being cost-effective at a £30,000 per QALY willingness-to-pay threshold was 88%. The results remained robust to a range of sensitivity analyses. Conclusion This within-trial economic evaluation found that it is probable that using a removable brace provides good value to the NHS when compared to cast, in the management of adults with ankle fracture. Cite this article: Bone Jt Open 2022;3(6):455–462.

Functional orthosis versus cast immobilization for weightbearing stable Weber B ankle fractures with concomitant unstable gravity stress tests

“…The British Orthopaedic Association Standards for Trauma recommend cast immobilization for partially unstable fractures, 12 but this approach carries risks such as muscle atrophy, deep vein thrombosis, and joint stiffness. More functional treatment options may avoid these concerns, offer better cost-effectiveness, 13 and may be preferred by patients. 14 A RCT comparing patient-reported outcomes and the safety of functional orthosis versus cast immobilization is needed to determine the best treatment approach for these fractures.…”