Volar locking plate versus external fixation for unstable dorsally displaced distal radius fractures-A 3-year cost-utility analysis.

Jenny Saving,Emelie Heintz,Anders Enocson,Hans Pettersson,Cecilia Mellstrand Navarro,Daniel Ribeiro

doi:10.1371/journal.pone.0240377

Jenny Saving, Emelie Heintz + Show 4 more

Open Access

https://doi.org/10.1371/journal.pone.0240377

Copy DOI

Abstract

To investigate the cost-effectiveness of Volar Locking Plate (VLP) compared to External Fixation (EF) for unstable dorsally displaced distal radius fractures in a 3-year perspective. During 2009-2013, patients aged 50-74 years with an unstable dorsally displaced distal radius fracture were randomised to VLP or EF. Primary outcome was the incremental cost-effectiveness ratio (ICER) for VLP compared with EF. Data regarding health effects (Quality-adjusted life years, QALYs) was prospectively collected during the trial period until 3 years after surgery. Cost data was collected retrospectively for the same time period and included direct and indirect costs (production loss). One hundred and thirteen patients (VLP n = 58, EF n = 55) had complete data until 3 years and were used in the analysis. At one year, the VLP group had a mean incremental cost of 878 euros and a gain of 0.020 QALYs compared with the EF group, rendering an ICER of 43 900 euros per QALY. At three years, the VLP group had a mean incremental cost of 1 082 euros and a negative incremental effect of -0.005 QALYs compared to the EF group, which means that VLP was dominated by EF. The probability that VLP was cost-effective compared to EF at three years, was lower than 50% independent of the willingness to pay per QALY. Three years after distal radius fracture surgery, VLP fixation resulted in higher costs and a smaller effect in QALYs compared to EF. Our results indicate that it is uncertain if VLP is a cost-effective treatment of unstable distal radius fractures compared to EF.

Highlights

The incidence of surgical treatment of distal radius fractures has increased since the introduction of the volar locking plate (VLP) at the turn of the 21st century [1]
The VLP group had a mean incremental cost of 1 082 euros and a negative incremental effect of -0.005 Quality-adjusted-life years (QALY) compared to the external fixation (EF) group, which means that VLP was dominated by EF
The probability that VLP was cost-effective compared to EF at three years, was lower than 50% independent of the willingness to pay per QALY

Summary

Introduction

The incidence of surgical treatment of distal radius fractures has increased since the introduction of the volar locking plate (VLP) at the turn of the 21st century [1]. There is little evidence to support that any surgical method yields superior clinical outcome as compared to others for treatment of distal radius fractures [4,5,6]. In a setting with limited health care resources, cost-effectiveness of different methods may be an important aspect to address in the choice of treatment, i.e. if the surgical methods have a reasonable incremental cost in relation to their effects. There is some evidence suggesting that VLP is not a cost-effective surgical technique when compared to percutaneous pinning [7,8]. The purpose of this study was to assess the cost-effectiveness of VLP versus EF for surgical treatment of patients 50–74 years old with a dorsally displaced distal radius fractures during the first 3 years after distal radius fracture surgery

Objectives

Methods

Results

Conclusion