TY - JOUR
T1 - Economic evaluation of operative versus nonoperative treatment of a humeral shaft fracture
T2 - economic analyses alongside a multicenter prospective cohort study (HUMMER)
AU - van Bergen, Saskia H.
AU - van Lieshout, Esther M. M.
AU - Mahabier, Kiran C.
AU - Geraerds, Alexandra J. L. M.
AU - Polinder, Suzanne
AU - den Hartog, Dennis
AU - Verhofstad, Michael H. J.
AU - the HUMMER Investigators
AU - Beetz, Ivo
AU - Bolhuis, Hugo W.
AU - Bos, P. Koen
AU - Bronkhorst, Maarten W. G. A.
AU - Bruijninckx, Milko M. M.
AU - de Haan, Jeroen
AU - Deenik, Axel R.
AU - den Hoed, P. Ted
AU - Eversdijk, Martin G.
AU - Goslings, J. Carel
AU - Haverlag, Robert
AU - Heetveld, Martin J.
AU - Kerver, Albertus J. H.
AU - Kolkman, Karel A.
AU - Leenhouts, Peter A.
AU - Meylaerts, Sven A. G.
AU - Onstenk, Ron
AU - Poeze, Martijn
AU - Poolman, Rudolf W.
AU - Punt, Bas J.
AU - Ritchie, Ewan D.
AU - Roerdink, W. Herbert
AU - Roukema, Gert R.
AU - Sintenie, Jan Bernard
AU - Soesman, Nicolaj M. R.
AU - ten Holder, Edgar J. T.
AU - Tuinebreijer, Wim E.
AU - van der Elst, Maarten
AU - van der Heijden, Frank H. W. M.
AU - van der Linden, Frits M.
AU - van der Zwaal, Peer
AU - van Dijk, Jan P.
AU - van Jonbergen, Hans-Peter W.
AU - Verleisdonk, Egbert J. M. M.
AU - Vroemen, Jos P. A. M.
AU - Waleboer, Marco
AU - Wittich, Philippe
AU - Zuidema, Wietse P.
AU - Al Khanim, Ahmed
AU - Bousema, Jelle E.
AU - Cheng, Kevin
AU - Claes, Yordy
AU - Joling, Boudijn S. H.
AU - Cnossen, J. Daniël
N1 - Funding Information: This project was supported by a grant from the Osteosynthesis and Trauma Care (OTC) Foundation (reference number 2013-DHEL). This organization was not involved in the study design, patient recruitment, data collection, data analysis, data interpretation, publication decisions, or in any aspect pertinent to this study. Publisher Copyright: © 2022, The Author(s).
PY - 2022
Y1 - 2022
N2 - Purpose: Operative treatment of a humeral shaft fracture results in faster recovery than nonoperative treatment. The cost-effectiveness, in terms of costs per Quality-Adjusted Life Year (QALY) gained (Dutch threshold €20,000-€80,000) or minimal important change (MIC) in disability reduced (DASH 6.7), is unknown. The aim of this study was to determine cost-utility and cost-effectiveness of operative versus nonoperative treatment in adults with a humeral shaft fracture type 12A or 12B. Methods: This study was performed alongside a multicenter prospective cohort study. Costs for health care and lost productivity until one year after trauma were calculated. The incremental cost-utility ratio (ICUR) was reported in costs per QALY (based on the EuroQoL-5D-3L (EQ-5D)) gained. The incremental cost-effectiveness ratio (ICER) was reported in costs per MIC (based on the DASH score at three months) reduced. Results: Overall, 245 patients were treated operatively and 145 nonoperatively. In the operative group, the mean total costs per patient (€11,925 versus €8793; p < 0.001) and QALYs (0.806 versus 0.778; p < 0.001) were higher. The ICUR of operative treatment was €111,860 per QALY gained (i.e., €3132/0.028). The DASH was 7.3 points (p < 0.001) lower in the operative group. The ICER of operative treatment was €2880 per MIC in disability reduced (i.e., €3132/7.3*6.7). Conclusion: Due to the limited effect of treatment on quality of life measured with the EQ-5D, the ICUR of operative treatment (€111,860 per QALY gained) exceeds the threshold. However, the incremental costs of €2880 per clinically meaningful difference in DASH are much lower and suggest that operative treatment for a humeral shaft fracture is cost-effective.
AB - Purpose: Operative treatment of a humeral shaft fracture results in faster recovery than nonoperative treatment. The cost-effectiveness, in terms of costs per Quality-Adjusted Life Year (QALY) gained (Dutch threshold €20,000-€80,000) or minimal important change (MIC) in disability reduced (DASH 6.7), is unknown. The aim of this study was to determine cost-utility and cost-effectiveness of operative versus nonoperative treatment in adults with a humeral shaft fracture type 12A or 12B. Methods: This study was performed alongside a multicenter prospective cohort study. Costs for health care and lost productivity until one year after trauma were calculated. The incremental cost-utility ratio (ICUR) was reported in costs per QALY (based on the EuroQoL-5D-3L (EQ-5D)) gained. The incremental cost-effectiveness ratio (ICER) was reported in costs per MIC (based on the DASH score at three months) reduced. Results: Overall, 245 patients were treated operatively and 145 nonoperatively. In the operative group, the mean total costs per patient (€11,925 versus €8793; p < 0.001) and QALYs (0.806 versus 0.778; p < 0.001) were higher. The ICUR of operative treatment was €111,860 per QALY gained (i.e., €3132/0.028). The DASH was 7.3 points (p < 0.001) lower in the operative group. The ICER of operative treatment was €2880 per MIC in disability reduced (i.e., €3132/7.3*6.7). Conclusion: Due to the limited effect of treatment on quality of life measured with the EQ-5D, the ICUR of operative treatment (€111,860 per QALY gained) exceeds the threshold. However, the incremental costs of €2880 per clinically meaningful difference in DASH are much lower and suggest that operative treatment for a humeral shaft fracture is cost-effective.
KW - Cost-effectiveness
KW - Cost-utility
KW - Fracture
KW - Health care consumption
KW - Humerus
KW - Nonoperative
KW - Operative
KW - Shaft
UR - http://www.scopus.com/inward/record.url?scp=85143790816&partnerID=8YFLogxK
U2 - https://doi.org/10.1007/s00068-022-02160-1
DO - https://doi.org/10.1007/s00068-022-02160-1
M3 - Article
C2 - 36480054
SN - 1863-9933
JO - European journal of trauma
JF - European journal of trauma
ER -