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Cost-effectiveness of post-reduction mandibular fracture imaging depends on complication rate

Researchers have determined that the cost-effectiveness of the post-reduction imaging of mandibular fractures depends on the complication rates of the facial traumatologist and institutional charge data.

The researchers created a decision tree to mirror clinical decision-making processes and the costs associated with assessing fracture reduction, including costs of imaging modalities, the adequacy of reduction, complication rates, the cost of initial operating room (OR) time and, when applicable, operative charges for revision surgery resulting from a complication. The model included three pathways for the surgeon: intraoperative CT, immediate postoperative panorex radiography and no imaging, and postoperative complications were defined as the need to return to the OR for any reason.

Using clinical data from the University of Virginia data repository for 100 de-identified patients treated recently for mandible fracture, the researchers estimated the costs associated with running an operating suite for mandibular fracture repair. They also performed a sensitivity analysis to determine how complication rate variation affected the cost of the decision pathways.

Regardless of complication rate, the researchers found intraoperative CT was always more expensive secondary to the increased OR time resulting from the use of intraoperative imaging.

When postreduction imaging was compared with no imaging, the breakpoint was 17.7%, according to the researchers.

The researchers determined that at a complication rate of greater than 17.7% requiring a return to the OR, obtaining postoperative panorex radiography was the most cost-effective option. However, at complication rates of less than 17.7%, no postoperative imaging was the most cost-effective choice. – by Abigail Sutton

Disclosures: The researchers report no relevant financial disclosures.