Volar locking plate versus external fixation for unstable dorsally displaced distal radius fractures–A 3-year cost-utility analysis

Abstract

To investigate the cost-effectiveness of Volar Locking Plate (VLP) compared to External Fixation (EF) for unstable dorsally displaced distal radius fractures in a 3-year perspective. Methods During 2009-2013, patients aged 50-74 years with an unstable dorsally displaced distal radius fracture were randomised to VLP or EF. Primary outcome was the incremental costeffectiveness ratio (ICER) for VLP compared with EF. Data regarding health effects (Quality-adjusted life years, QALYs) was prospectively collected during the trial period until 3 years after surgery. Cost data was collected retrospectively for the same time period and included direct and indirect costs (production loss). Results One hundred and thirteen patients (VLP n = 58, EF n = 55) had complete data until 3 years and were used in the analysis. At one year, the VLP group had a mean incremental cost of 878 euros and a gain of 0.020 QALYs compared with the EF group, rendering an ICER of 43 900 euros per QALY. At three years, the VLP group had a mean incremental cost of 1 082 euros and a negative incremental effect of-0.005 QALYs compared to the EF group, which means that VLP was dominated by EF. The probability that VLP was cost-effective compared to EF at three years, was lower than 50% independent of the willingness to pay per QALY.

A Cost-Effectiveness Analysis of the Various Treatment Options for Distal Radius Fractures

“…In a randomized study of patients aged 65 years and older with displaced DRFs, Hassellund et al 24 found that volar plating was not cost effective compared with nonsurgical treatment from the health care perspective despite significantly higher health-related quality of life associated with surgical treatment. In a randomized study of patients aged 50–74 years with unstable dorsally displaced fractures, Saving et al 25 found that volar plating resulted in higher costs and a smaller quality of life benefit compared with external fixation. Yoon et al 26 concluded that casting and percutaneous pinning were the most cost-effective treatment strategies for closed extra-articular fractures and closed unstable fractures, respectively, in patients aged 60 years and older.…”

“…All transition-state probabilities and ranges can be seen in Table 1 . 3 , 5 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , …”

LIMPER trials: immediate mobilisation versus 2-week cast immobilisation after distal radius fracture treated with volar locking plate – a study protocol for a prospective, randomised, controlled trial

“…Postoperative casting also uses expensive resources, such as time spent in the OR and visits to outpatient clinics for cast fixing or removal. 18 Moreover, the restoration of wrist function and the reduction of impairment is important considering that more than 50% of DRF patients are still of working age. A mean sick leave duration of 4–12 weeks has been reported, which means sick leave after DRF has an important socioeconomical role.…”

“…After primary intervention, DRFs are associated with the use of multiple resources, including operative interventions, outpatient visits and rehabilitation. Postoperative casting also uses expensive resources, such as time spent in the OR and visits to outpatient clinics for cast fixing or removal 18. Moreover, the restoration of wrist function and the reduction of impairment is important considering that more than 50% of DRF patients are still of working age.…”

A comparative study protocol of external fixation versus volar plate in treating distal radius fracture

“…Due to the variability and complexity of a single series of fractures or the distinct techniques utilized between the cases, the clear conclusions are difficult to be obtained. [ 17 – 19 ]…”