Speaker outlines cost-effective treatments for distal radius fractures in older adults
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Compared with casting or percutaneous pinning, volar locking plate and external fixation are not cost-effective interventions for the treatment of closed extra-articular distal radius fractures in older adults, according to results.
“Each intervention has its strengths and weaknesses,” Alfred P. Yoon, MD, from the University of Michigan Health System, said in his presentation at the American Society for Surgery of the Hand Annual Meeting, which was held as a virtual meeting.
“For example, pinning is less invasive and cheaper compared to other surgical interventions, but not may not reliably maintain reductions for common fractures,” Yoon said. “On the other hand, volar locking plates are expensive and invasive but provide a stable reduction.”
As part of their randomized, multicenter clinical trial, Yoon and colleagues from the Wrist and Radius Injury Surgical Trial group included 296 patients older than 60 years with closed extra-articular distal radius fractures (DRFs). Patients were separated into four groups based on intervention style: a volar locking plate (VLP) group (n = 75); an external fixation (ex-fix) group (n = 60); a closed reduction percutaneous pinning (CRPP) group (n = 51); and a casting group (n = 110).
According to the study, Yoon and colleagues used Medicare and Healthcare Cost and Utilization Project data to estimate medical costs. They also calculated quality-adjusted life years (QALYs) and incremental cost-effectiveness ratio (ICER) for each procedure. Overall cost-effectiveness was assessed with a willingness-to-pay threshold of $100,000/QALY.
Average total cost associated with each procedure was $16,232 for VLP, $15,426 for ex-fix, $10,818 for CRPP and $5,483 for casting, according to the study.
“VLP and ex-fix were both more expensive and yielded fewer QALY compared with CRPP or casting,” Yoon said.
After performing probabilistic sensitivity analysis, Yoon and colleagues found the chance of being cost-effective at the willingness-to-pay threshold of $100,000/QALY for each procedure was 9% for VLP, 4% for ex-fix, 52% for CRPP and 34% for casting.
When performing sensitivity analysis on just CRPP and casting, Yoon and colleagues found postoperative utilities and age at the time of injury to be most important factors to influence cost-effectiveness.
“Because CRPP is more expensive than casting and the 12-month health utility after pain is less than 0.71 or 12-month utility of casting is greater than 0.71, CRPP became no longer cost-effective compared with casting,” he said.
While casting is the preferred for closed DRFs, Yoon noted CRPP was the most cost-effective surgical intervention for unstable, closed fractures.
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Yoon AP, et al. Paper 6. Presented at: American Society for Surgery of the Hand Annual Meeting; Oct. 1-3, 2020 (virtual meeting).
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