Abstract
Introduction and Aims: Treatment of the displaced intra-articular calcaneal fracture (DIACF) has long been a source of uncertainty in orthopaedic surgery. To evaluate the cost-effectiveness of operative versus non-operative management of this fracture, a model was constructed based on a randomised clinical trial. Model outputs were costs and quality-adjusted life years (QALYs).
Method: A decision tree was constructed to model the effect on costs and quality-adjusted life years (QALYs) of operative versus non-operative management for DIACFs. Complication rate, fusion rate, survival data, productivity losses and patient utilities were estimated from a recent prospective randomised control trial. Four-year costs were estimated from the centre treating 73% of the patients. A societal perspective was used in the primary analysis. Future costs and benefits were discounted at 5% and reported in 2002 Canadian dollars. One-way sensitivity analysis and a multi-way Monte Carlo simulation were performed incorporating all ranges of values for the utilities, costs and probabilities.
Results: When productivity losses were included, operative management was less costly ($13,000 cost saving) and had an incremental gain of .06 QALYs, based on improvements in health-related quality of life, thus, making it the dominant strategy compared to non-operative treatment. The cost-effectiveness was most sensitive to the estimates of the productivity losses. When productivity losses were excluded, the increase in cost of operative treatment was $2700 for an incremental gain of .06 QALYs, giving an incremental cost-utility (CU) ratio of $44,000 per QALY gained. The outcome of the analysis remained stable with the remainder of the one-way and multi-way sensitivity analysis. Of the 2000 iterations, with Monte Carlo simulation when productivity losses were included, 80% resulted in cost-effectiveness ratios less than $50,000 per QALY gained for operative treatment. When productivity losses were excluded, 53% of the 2000 iterations resulted in cost-effectiveness ratios less than $50,000.
Conclusion: The treatment of the DIACF has long been a source of uncertainty in orthopaedic surgery. The cost-effectiveness of operative management indicates that it is a moderately economically attractive treatment (a CU ratio of < $50,000). Further exploration of the impact of productivity losses is required.
These abstracts were prepared by Editorial Secretary, George Sikorski. Correspondence should be addressed to Australian Orthopaedic Association, Ground Floor, The William Bland Centre, 229 Macquarie Street, Sydney, NSW 2000, Australia.
One or more of the listed authors are receiving or have received benefits or support from a recognised academic body for the pursuance of the study.
