Abstract
PurposeThe purpose of this study was to evaluate the cost-effectiveness of introducing cone-beam computed tomography (CBCT) in the management of the complex finger fractures with articular involvement.MethodsWe created a decision tree model simulating the diagnostic pathway of complex finger fractures, suggesting the use of CBCT as alternative to multi-slice computed tomography (MSCT), and we compared their clinical outcomes, costs, and cost-effectiveness for a hypothetical cohort of 10,000 patients. Measures of effectiveness are analysed by using quality-adjusted life years, incremental cost-effectiveness ratio, and net monetary benefit.ResultsDiagnosis of a complex finger fracture performed with CBCT costed 67.33€ per patient, yielded 9.08 quality-adjusted life years, and gained an incremental cost-effectiveness ratio of 29.94€ and a net monetary benefit of 9.07 € at 30,000€ threshold. Using MSCT for diagnosis costed 106.23 €, yielded 8.18 quality-adjusted life years, and gained an incremental cost-effectiveness ratio of 371.15 € and a net monetary benefit of 8.09 €. CBCT strategy dominated the MSCT strategy. The acceptability curve shows that there is 98% probability of CBCT being the optimal strategy at 30,000€ threshold (1 EUR equal to 1.11 USD; updated on 02/02/2020).ConclusionCBCT in complex finger fractures management is cost saving compared with MSCT and may be considered a valuable imaging tool in preoperative assessment, allowing early detection and appropriate treatment. It shortens the time to completion of diagnostic work-up, reduces the number of additional diagnostic procedures, improves quality of life, and may reduce costs in a societal perspective.
Highlights
Finger fractures are frequent injuries, comprising 10–25% of all fracture-related visits in Emergency Department [1, 2]
multi-slice computed tomography (MSCT) is superior to conventional radiography (CR) in demonstrating intra-articular fracture lines and in the accuracy of fracture measurements because of slice thickness, isotropic, high-resolution multiplanar reconstruction (MPR) [16, 17, 21, 22]
The aim of this study is to investigate the cost and clinical effectiveness of cone-beam computed tomography (CBCT) as a diagnostic alternative in complex finger fractures compared with MSCT, using formal cost-effectiveness principles
Summary
The final decision on the fracture’s management is based largely on clinical impairment of hand function, considering comorbidities, compliance, and the need to return to activities or work [6,7,8] In this regard, conventional radiography (CR) represents the first-line imaging tool for the evaluation of metacarpal and finger fractures [14, 15]. Multi-slice computed tomography (MSCT) is not routinely performed in acute stage of injury [14, 15] It can, be useful in assessment of articular surface involvement for detection of small bone fragments and in case of joint subluxation [6, 7, 10, 16]. Disadvantages of CBCT include higher radiation doses than conventional radiography, a limited contrast resolution, and the presence of various types of image artefacts [25]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
