Is reduction of routine radiograph use in patients with distal radius fractures cost effective? Analysis of data from the multicentre, randomised controlled WARRIOR trial. Issue 7 (5th July 2020)

• Record Type: Journal Article
• Authors: van Gerven, Pieter; van Dongen, Johanna M; Rubinstein, Sidney M; Termaat, Marco F; El Moumni, Mostafa; Zuidema, Wietse P.; Krijnen, Pieta; Schipper, Inger B; van Tulder, Maurits W
• Other Names: author non-byline.; van Bodegom-Vos L author non-byline.; Breederveld RS author non-byline.; Derksen RJ author non-byline.; van Dijkman B author non-byline.; Goslings JC author non-byline.; Hegeman JH author non-byline.; Hoogendoorn JM author non-byline.; van Kuijk C author non-byline.; Meylaerts SAG author non-byline.; Rosendaal FR author non-byline.; Weil NL author non-byline.; Wendt KW author non-byline.
• Is Part Of: BMJ open. Volume 10:Issue 7(2020)
• Publication Date: 2020-07-05
• Subjects: health economics -- foot & ankle -- radiology & imaging -- orthopaedic & trauma surgery -- health economics; Medicine -- Research -- Periodicals; 610.72
• DOI: 10.1136/bmjopen-2019-035370
• Languages: English
• ISSNs: 2044-6055

Abstract

Abstract : 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).