Cost-utility analysis of surgical fixation with Kirschner wire versus casting after fracture of the distal radius A HEALTH ECONOMIC EVALUATION OF THE DRAFFT2 TRIAL

摘要

Aims The aim of this study was to compare the cost-effectiveness of surgical fixation with Kirschner (K-)wire ersus moulded casting after manipulation of a fracture of the distal radius in an operating theatre setting. Methods An economic evaluation was conducted based on data collected from the Distal Radius Acute Fracture Fixation Trial 2 (DRAFFT2) multicentre randomized controlled trial in the UK. Resource use was collected at three, six, and 12 months post-randomization using trial case report forms and participant-completed questionnaires. Cost-effectiveness was reported in terms of incremental cost per quality-adjusted life year (QALY) gained from an NHS and personal social services perspective. Sensitivity analyses were conducted to examine the robustness of cost-effectiveness estimates, and decision uncertainty was handled using confidence ellipses and cost-effectiveness acceptability curves. Results In the base case analysis, surgical fixation with K-wire was more expensive (￡29.65 (95 confidence interval (Cl) -94.85 to 154.15)) and generated lower QALYs (0.007 (95 Cl -0.03 to 0.016)) than moulded casting, but this difference was not statistically significant. The probability of K-wire being cost-effective at a ￡20,000 per QALY cost-effectiveness threshold was 24. The cost-effectiveness results remained robust in the sensitivity analyses. Conclusion The findings suggest that surgical fixation with K-wire is unlikely to be a cost-effective alternative to a moulded cast in adults, following manipulation of a fracture of the distal radius in a theatre setting.