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


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Abstract

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 case difference 12 weeks).Conclusions:The cost-effectiveness of ORIF after acute clavicle fracture depended on the durability of functional advantage for ORIF compared with nonoperative treatment. When functional benefits persisted for more than 9 years, ORIF had a favorable value compared with many accepted health interventions.

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