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Is reduction of routine radiograph use in patients with distal radius fractures cost effective? Analysis of data from the multicentre, randomised controlled WARRIOR trial
OBJECTIVE: To assess the cost effectiveness of a reduced imaging follow-up protocol of distal radius fractures compared with usual care. DESIGN: An economical evaluation conducted alongside a multicentre randomised controlled trial (RCT). SETTING: Four level-one trauma centres in the Netherlands. PA...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7337891/ https://www.ncbi.nlm.nih.gov/pubmed/32624472 http://dx.doi.org/10.1136/bmjopen-2019-035370 |
Sumario: | OBJECTIVE: To assess the cost effectiveness of a reduced imaging follow-up protocol of distal radius fractures compared with usual care. DESIGN: An economical evaluation conducted alongside a multicentre randomised controlled trial (RCT). SETTING: Four level-one trauma centres in the Netherlands. PARTICIPANTS: 341 patients participated (usual care (n=172), reduced imaging (n=169)). INTERVENTIONS: Patients were randomised to usual care (routine radiography at 1, 2, 6 and 12 weeks) or a reduced imaging strategy (radiographs at 6 and 12 weeks only for a clinical indication). OUTCOME MEASURES: Functional outcome was assessed using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and quality-adjusted life years (QALYs) using the EuroQol-5Dimensions-3 Levels (EQ-5D-3L). Costs were measured using self-reported questionnaires and medical records, and analysed from a societal perspective. Multiple imputation, seemingly unrelated regression analysis and bootstrapping were used to analyse the data. RESULTS: Clinical overall outcomes of both groups were comparable. The difference in DASH was −2.03 (95% CI −4.83 to 0.77) and the difference in QALYs was 0.025 (95% CI −0.01 to 0.06). Patients in the reduced imaging group received on average 3.3 radiographs (SD: 1.9) compared with 4.2 (SD: 1.9) in the usual care group. Costs for radiographic imaging were significantly lower in the reduced imaging group than in the usual care group (€−48 per patient, 95% CI −68 to −27). There was no difference in total costs between groups (€−401 per patient, 95% CI −2453 to 1251). The incremental cost-effectiveness ratio (ICER) for QALYs was −15 872; the ICER for the DASH was 198. The probability of reduced imaging being cost effective compared with usual care ranged from 0.8 to 0.9 at a willingness to pay of €20 000/QALY to €80 000/QALY. CONCLUSIONS: Implementing a reduced imaging strategy in the follow-up of distal radius fractures has a high probability of being cost effective for QALYs, without decreasing functional outcome. We, therefore, recommend imaging only when clinically indicated. TRIAL REGISTRATION NUMBER: The Netherlands trial register (NL4477). |
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