Abstract
PurposeTo allow physicians to be more selective in their request for a radiograph of the wrist and to potentially reduce costs, the Amsterdam Wrist Rules (AWR) have been developed, externally validated, and recently also implemented. The aim of this study was to conduct an incremental cost analysis and budget impact analysis of the implementation of the AWR at the emergency department (ED) in the Netherlands.MethodsA cost-minimisation analysis to determine the expected cost savings for implementation of the Amsterdam Wrist Rules. The incremental difference in costs before and after implementation of the AWR was based on the reduction in costs for radiographs, the cost savings due to reduction of ED consultation times and the costs of a re-evaluation appointment by a physician.ResultsIn the Netherlands, implementation of the AWR could potentially result in 6% cost savings per patient with a wrist injury. In addition, implementation of the AWR resulted in €203,510 cost savings annually nationwide. In the sensitivity analysis, an increase in physician compliance to 100% substantially increased the potential total amount of annual cost savings to €610,248, which is 6% of total costs before implementation. Variation in time spent at the ED, a decrease and increase in costs and patients presenting annually at the ED did not change the cost savings substantially.ConclusionImplementation of the AWR has been shown to reduce direct and indirect costs and can, therefore, result in considerable savings of healthcare consumption and expenditure.
Highlights
IntroductionOnly half of the patients who present at the emergency department (ED) have sustained a fracture of the wrist [1, 2]
A trauma of the wrist is a common reason for a patient to present at the emergency department (ED)
In the sensitivity analysis, when considering the reduction in radiographs due to an increase in physician compliance of 50%, 75% and 100%, a total amount of €3519, €5472 and €7425, respectively, could potentially be saved
Summary
Only half of the patients who present at the ED have sustained a fracture of the wrist [1, 2]. Almost all patients undergo radiographs of the wrist. Even though the costs per radiograph are limited, due to the high incidence of wrist trauma the cumulative costs can be substantial. To allow physicians to be more selective in their request for a radiograph, the Amsterdam Wrist Rules (AWR) have been developed, externally validated [1], and recently implemented [5]. Based on the age of the patient and several clinical variables present during physical examination, the AWR provide a recommendation to request a radiograph of the wrist or not in patients suspected of a distal radius
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