Advertisement for orthosearch.org.uk
Orthopaedic Proceedings Logo

Receive monthly Table of Contents alerts from Orthopaedic Proceedings

Comprehensive article alerts can be set up and managed through your account settings

View my account settings

Visit Orthopaedic Proceedings at:

Loading...

Loading...

Full Access

General Orthopaedics

ECONOMIC EVALUATION OF REAMED VERSUS UNREAMED INTRAMEDULLARY NAILING IN PATIENTS WITH CLOSED AND OPEN TIBIAL FRACTURES: RESULTS FROM THE STUDY TO PROSPECTIVELY EVALUATE REAMED INTRAMEDULLARY NAILS IN PATIENTS WITH TIBIAL FRACTURES (S.P.R.I.N.T.)

Canadian Orthopaedic Association (COA)



Abstract

Purpose

Using utilities and other outcome data collected prospectively on all SPRINT patients and cost data collected from a sample of SPRINT patients, we compared reamed and unreamed intramedullary nailing using a cost-utility analysis.

Method

Participants completed the Health Utility Index 3 (HUI) questionnaire at two weeks after hospital discharge, and three, six, and 12 months post-surgery. We calculated quality adjusted life years (QALYs) for each patient for the first 12 months following intramedullary nailing. A convenience sample of 235 SPRINT patients with similar baseline characteristics provided data on healthcare resource utilization. Costs associated with the healthcare resource utilization were obtained from the 2008 Physicians Schedule of Benefits and a Case Costing System.

Results

We found small, non-significant differences in QALYs for patients treated with reamed compared with unreamed intramedullary nails in both closed and open fractures: −0.017 (95% CI −0.021, 0.058) and −0.002 (95% CI −0.060, 0.062) respectively. The incremental costs for reamed compared with unreamed intramedullary nailing were $51 CAN (95% CI −$2,298, $2,400) in closed tibial fractures and $2,546 CAN (95% CI −$1,773, $6,864) in open tibial fractures.

Conclusion

Considering point estimates only, reamed intramedullary nailing was less effective and more costly when compared to unreamed intramedullary nailing for both closed and open tibial fractures. Bootstrap simulations revealed that unreamed nailing was more likely to be cost-effective for both open and closed tibial fractures at all decision-making thresholds. Confidence intervals around both cost and utility estimates were wide and neither approached conventional levels of statistical significance.