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Cost-effectiveness analysis of cast versus splint in children with acceptably angulated wrist fractures

Published online by Cambridge University Press:  29 March 2011

Camilla von Keyserlingk ,
Kathy Boutis ,
Andrew R. Willan ,
Robert Borden Hopkins  and
Ron Goeree
Camilla von Keyserlingk
Affiliation:
St. Joseph's Healthcare Hamilton
Kathy Boutis
Affiliation:
University of Toronto and Hospital for Sick Children
Andrew R. Willan
Affiliation:
University of Toronto and SickKids Research Institute
Robert Borden Hopkins
Affiliation:
McMaster University and St. Joseph's Healthcare Hamilton
Ron Goeree
Affiliation:
McMaster University and St. Joseph's Healthcare Hamilton
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Abstract

Objectives: In a practice setting where casting is considered the standard of care, the aim of this study was to assess the cost-effectiveness of wrist splints compared with routine casting in children with acceptably angulated distal radius greenstick or transverse fractures.

Methods: A cost-effectiveness analysis was conducted alongside a randomized controlled trial (RCT). One hundred children with acceptably angulated distal radius greenstick or transverse fractures received either a wrist splint or cast. Information on health care provider and patient and family resource use as well as productivity cost was collected. Resource use was costed using unit costs from local administrative data sources and expense diaries. Effectiveness was assessed at 6 weeks using the performance version of the Activities Scale for Kids (ASKp) questionnaire. Cost-effectiveness analysis related differential costs to differential ASKp scores.

Results: Mean total cost was $877.58 in the splint group and $950.35 in the cast group, with a mean difference of $−72.76 (standard error [SE] 45.88). Mean total healthcare cost was $670.66 in the splint group and $768.22 in the cast group, with a mean difference of $−97.56 (SE 9.24). Mean (SE) ASKp was 92.8 in the splint group and 91.4 in the cast group, with a mean difference of 1.439 (SE 1.585). Therefore, splint management was more effective and cheaper. After accounting for uncertainty, the probability of splint being cost-effective compared with cast was 94 percent for a willingness-to-pay threshold value of $0 for one-unit gain in ASKp score and exceeded 82 percent for all threshold values.

Conclusions: In this RCT, splint management was cost-effective compared with casting in children with acceptably angulated distal radius greenstick or transverse fractures. This study challenges the existing standard of care for children with this type of fracture and provides justification on clinical and economic grounds for a change in routine practice.

Keywords

Cost-effectiveness analysisPediatricsWristFractures (bone)Casts (surgical)Splints
Type
ASSESSMENTS
Information
International Journal of Technology Assessment in Health Care , Volume 27 , Issue 2 , April 2011 , pp. 101 - 107
Copyright
Copyright © Cambridge University Press 2011

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References

REFERENCES

1. Abraham, A, Handoll, HH, Khan, T. Interventions for treating wrist fractures in children. Cochrane Database Syst Rev. 2008;CD004576.CrossRefGoogle Scholar
2. Al-Ansari, K, Howard, A, Seeto, B, et al. Minimally angulated pediatric wrist fractures: Is immobilization without manipulation enough? CJEM. 2007;9:9–15.CrossRefGoogle Scholar
3. Bohm, ER, Bubbar, V, Yong, HK, Dzus, A. Above and below-the-elbow plaster casts for distal forearm fractures in children. A randomized controlled trial. J Bone Joint Surg Am. 2006;88:1–8.Google ScholarPubMed
4. Boutis, K, Willan, A, Babyn, P, Goeree, R, Howard, A. Cast versus splint in children with minimally angulated fractures of the distal radius: Randomized controlled trial. CMAJ. 2010;182:1507–1512.CrossRefGoogle ScholarPubMed
5. Brazier, B, Ratcliffe, J, Salomon, JS, Tsuchiya, A. Measuring and valuing health benefits for economic evaluation. Oxford: Oxford University Press; 2007.Google Scholar
6. Community Pharmacy in Canada. Executive Summary: Trends & Insights 2007 Survey of Pharmacists. The Pharmacy Group 2008. http://www.tevacanada.com/Pdfs/Community_Pharmacy-Report.aspx (accessed November 5 2009).Google Scholar
7. Davidson, JS, Brown, DJ, Barnes, SN, Bruce, CE. Simple treatment for torus fractures of the distal radius. J Bone Joint Surg Br. 2001;83:1173–1175.CrossRefGoogle ScholarPubMed
8. Do, TT, Strub, WM, Foad, SL, Mehlman, CT, Crawford AH. Reduction versus remodeling in pediatric distal forearm fractures: A preliminary cost analysis. J Pediatr Orthop B. 2003;12:109–115.Google ScholarPubMed
9. Farbman, KS, Vinci, RJ, Cranley, WR, Creevy, WR, Bauchner, H. The role of serial radiographs in the management of pediatric torus fractures. Arch Pediatr Adolesc Med. 1999;153:923–925.CrossRefGoogle ScholarPubMed
10. Ferris, BD, Thomas, NP, Dewar, ME, Simpson, DA. Brace treatment of Colles' fracture. Acta Orthop Scand. 1989;60:63–65.CrossRefGoogle ScholarPubMed
11. Firmin, F, Crouch, R. Splinting versus casting of “torus” fractures to the distal radius in the paediatric patient presenting at the emergency department (ED): A literature review. Int Emerg Nurs. 2009;17:173–178.CrossRefGoogle Scholar
12. Hawkins, BJ, Bays, PN. Catastrophic complication of simple cast treatment: Case report. J Trauma. 1993;34:760–762.CrossRefGoogle ScholarPubMed
13. Michelson, JD, Ahn, U, Magid, D. Economic analysis of roentgenogram use in the closed treatment of stable ankle fractures. J Trauma. 1995;39:1119–1122.CrossRefGoogle ScholarPubMed
14. Ministry of Health and Long-term Care. Ontario regulation made under the Ontario Drug Benefit Act. Amending O. Reg. 201/96 (General). http://www.health.gov.on.ca/english/public/legislation/drugs/drug_regulation.html (accessed November 5 2009).Google Scholar
15. Ministry of Health and Long-term Care. Ontario case costing initiative. http://www.occp.com/ (accessed November 5 2009).Google Scholar
16. Ministry of Health and Long-term Care. Ontario Drug Benefit Formulary. [updated 2009 Apr 13; cited 2009 Oct 26] http://www.healthinfo.moh.gov.on.ca/formulary/index.jsp. 2010.Google Scholar
17. Ministry of Health and Long-term Care. Ontario Health Insurance Plan (OHIP). Schedule of Benefits and Fees. Physicians Services. Consultations and visits. http://www.health.gov.on.ca/english/providers/program/ohip/sob/physserv/physserv_mn.html (accessed October 23, 2009).Google Scholar
18. Oakley, EA, Ooi, KS, Barnett, PL. A randomized controlled trial of 2 methods of immobilizing torus fractures of the distal forearm. Pediatr Emerg Care. 2008;24:65–70.CrossRefGoogle ScholarPubMed
19. Pershad, J, Williams, S, Wan, J, Sawyer, JR. Pediatric distal radial fractures treated by emergency physicians. J Emerg Med. 2009;37:341–344.CrossRefGoogle ScholarPubMed
20. Plint, AC, Perry, JJ, Correll, R, Gaboury, I, Lawton, L. A randomized, controlled trial of removable splinting versus casting for wrist buckle fractures in children. Pediatrics. 2006;117:691–697.Google Scholar
21. Price, C. Management of fractures. In: Morrissy, W, ed. Lovell & Winters pediatric orthopaedics. Philadelphia: Lippincott Williams & Wilkins; 2006.Google Scholar
22. Randsborg, PH, Sivertsen, EA. Distal radius fractures in children: Substantial difference in stability between buckle and greenstick fractures. Acta Orthop. 2009;80:585–589.Google Scholar
23. Sarmiento, A, Zagorski, JB, Sinclair, WF. Functional bracing of Colles' fractures: A prospective study of immobilization in supination vs. pronation. Clin Orthop Relat Res. 1980;175–183.CrossRefGoogle Scholar
24. Statistics Canada. Consumer price indexes. Table: Consumer Price Index, health and personal care, by province (monthly). http://www40.statcan.gc.ca/l01/cst01/cpis13a-eng.htm (accessed November 24, 2009).Google Scholar
25. Statistics Canada. Labour Table: Average hourly wages of employees by selected characteristics and profession, unadjusted data by province (monthly). http://www40.statcan.ca/101/cst01/cst01/labr80-eng.htm (accessed October 29, 2009).Google Scholar
26. Statistics Canada. Prices and price indexes. Consumer price indexes. Gasoline and fuel oil, average retail prices by urban centre. Table: Regular unleaded gasoline at self-serve filling stations. http://www40.statcan.gc/101/cst01/econ154a-eng.htm (accessed October 23, 2009).Google Scholar
27. Symons, S, Rowsell, M, Bhowal, B, Dias, JJ. Hospital versus home management of children with buckle fractures of the distal radius. A prospective, randomised trial. J Bone Joint Surg Br. 2001;83:556–560.CrossRefGoogle ScholarPubMed
28. Waters, PM. Distal radius and ulna fractures. In: Beaty, JH, Kasser, JR, eds. Fractures in children. Philadelphia: Lippincott Williams & Wilkins; 2001.Google Scholar
29. Wilkins, KE. Principles of fracture remodeling in children. Injury. 2005;36 (Suppl 1):A3–A11.Google Scholar
30. Young, NL, Williams, JI, Yoshida, KK, Bombardier, C, Wright, JG. The context of measuring disability: Does it matter whether capability or performance is measured? J Clin Epidemiol. 1996;49:1097–1101.CrossRefGoogle ScholarPubMed
31. Young, NL, Williams, JI, Yoshida, KK, Wright, JG. Measurement properties of the activities scale for kids. J Clin Epidemiol. 2000;53:125–137.Google Scholar
32. Young, NL, Wright, JG. Measuring pediatric physical function. J Pediatr Orthop. 1995;15:244–253.CrossRefGoogle ScholarPubMed
33. Young, NL, Yoshida, KK, Williams, JI, Bombardier, C, Wright, JG. The role of children in reporting their physical disability. Arch Phys Med Rehabil. 1995;76:913–918.CrossRefGoogle ScholarPubMed
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