Slings may remain most cost-effective option for displaced midshaft clavicle fractures
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According to published results, surgeons should make the cost-conscious decision to treat displaced midshaft clavicle fractures with a sling compared with open reduction and internal fixation with a plate.
To determine the cost-effectiveness of open reduction and internal fixation (ORIF) with a plate vs. sling for displaced midshaft clavicle fractures, Kevin C. Wall, MD, MPH, and colleagues analyzed six studies that directly compared ORIF with a plate to treatment with a sling. Researchers also analyzed 18 studies that included fractures treated with either a plate, a sling or both methods.
Primary analysis was conducted by calculating incremental cost-effectiveness ratios (ICERs) using quality-adjusted life-years (QALYs), while secondary analysis included probabilistic sensitivity analysis (PSA), according to the study.
Overall, ORIF with a plate had a cost of $34,970, and slings had a cost of $18,850. After primary analysis, Wall and colleagues found plate fixation accumulated 46.02 QALYs compared with 45.99 QALYs for slings at 64 months. They determined plate management was not cost-effective relative to sling management, with an ICER of $606,957/QALY at a willingness-to-pay (WTP) threshold of $100,000.
PSA found slings were cost-effective across all WTP ranges. The ICER decreased from $606,957/QALY to $75,230/QALY – falling below the WTP threshold of $100,000; however, the strength of this evidence was not as strong compared with the primary analysis, Wall and colleagues noted.
“We believe that our primary analysis, by drawing these rates strictly from pertinent randomized controlled trials, to be the more significant and reliable ICER,” the researchers wrote in the study. “Because neither option is dominant in this model, both plate and sling remain viable approaches, although the cost-conscious decision will be to treat these fractures with a sling until future data suggest otherwise.”
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