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

• Published in: PloS one Vol. 15; no. 10; p. e0240377
• Main Authors: Saving, Jenny, Heintz, Emelie, Pettersson, Hans, Enocson, Anders, Mellstrand Navarro, Cecilia
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 08.10.2020; Public Library of Science (PLoS)
• Subjects: Aged; Antibiotics; Arm injuries; Biology and Life Sciences; Bone Plates; Care and treatment; Comparative analysis; Cost analysis; Cost-Benefit Analysis; Displacement; Education; External Fixators; Female; Fixation; Follow-Up Studies; Fracture Fixation - economics; Fracture Fixation - methods; Fracture repair; Fractures; Hospitals; Humans; Locking; Medicin och hälsovetenskap; Medicine and Health Sciences; Methods; Middle Aged; Patients; People and Places; Quality of life; Quality-Adjusted Life Years; Radius Fractures - surgery; Retrospective Studies; Sick leave; Social Sciences; Surgery; Trauma; Sweden; Switzerland
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0240377

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. 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 cost-effectiveness 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). 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. Three years after distal radius fracture surgery, VLP fixation resulted in higher costs and a smaller effect in QALYs compared to EF. Our results indicate that it is uncertain if VLP is a cost-effective treatment of unstable distal radius fractures compared to EF.