Is Surgery for Displaced, Midshaft Clavicle Fractures in Adults Cost-Effective? Results Based on a Multicenter Randomized, Controlled Trial

作者：Adam M. Pearson, Anna N.A. Tosteson, Kenneth J. Koval, Michael D. McKee, Robert V. Cantu, John Erik Bell, Milena Vicente · 发表于：Journal of Orthopaedic Trauma · 年份：2010 · DOI：10.1097/bot.0b013e3181c3e505 · 被引用次数：94 · 研究领域：Shoulder and Clavicle Injuries、Trauma Management and Diagnosis、Shoulder Injury and Treatment

OBJECTIVES: To determine the cost-effectiveness of open reduction internal fixation (ORIF) of displaced, midshaft clavicle fractures in adults. DESIGN: Formal cost-effectiveness analysis based on a prospective, randomized, controlled trial. SETTING: Eight hospitals in Canada (seven university-affiliated and one community hospital). PATIENTS/PARTICIPANTS: One hundred thirty-two adults with acute, completely displaced, midshaft clavicle fractures. INTERVENTION: Clavicle ORIF versus nonoperative treatment. MAIN OUTCOME MEASUREMENTS: Utilities derived from SF-6D. RESULTS: The base case cost per quality-adjusted life-year (QALY) gained for ORIF was $65,000. Cost-effectiveness improved to $28,150/QALY gained when the functional benefit from ORIF was assumed to be permanent with cost per QALY gained falling below $50,000 when the functional advantage persisted for 9.3 years or more. In other sensitivity analyses, the cost per QALY gained for ORIF fell below $50,000 when ORIF cost less than $10,465 (base case cost $13,668) or the long-term utility difference between nonoperative treatment and ORIF was greater than 0.034 (base case difference 0.014). Short-term disutility associated with fracture healing also affected cost-effectiveness with the cost per QALY gained for ORIF falling below $50,000 when the utility of a fracture treated nonoperatively before union was less than 0.617 (base case utility 0.706) or when nonoperative treatment increased the time to union by 20 weeks (base c...