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. (1st November 2022)

• Record Type: Journal Article
• Authors: Png, May Ee; Petrou, Stavros; Achten, Juul; Ooms, Alexander; Lamb, Sarah E.; Hedley, Helen; Dias, Joseph; Costa, Matthew L.
• Is Part Of: Bone & joint journal. Volume 104B:Number 11(2022)
• Page Start: 1225
• Page End: 1233
• Publication Date: 2022-11-01
• Subjects: Cost -- Effectiveness -- Trial -- Distal radius -- Fracture -- K-wire -- Cast -- fractures of the distal radius -- surgical fixation -- Kirschner (K-)wire -- Distal Radius Acute Fracture Fixation Trial 2 -- multicentre randomized controlled trial -- t-tests -- K-wire fixation -- plaster cast -- EQ-5D-5L -- extension of fracture; Bones -- Surgery -- Periodicals; Joints -- Surgery -- Periodicals; Orthopedic surgery -- Periodicals; 617.47005
• DOI: 10.1302/0301-620X.104B11.BJJ-2022-0386.R1
• Languages: English
• ISSNs: 2049-4394

Abstract

Abstract : 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 (CI) -94.85 to 154.15)) and generated lower QALYs (0.007 (95% CI -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. Cite this article: Bone Joint J 2022;104-B(11):1225–1233.