Economic Evaluation of Reamed versus Unreamed Intramedullary Nailing in Patients with Closed and Open Tibial Fractures: Results from the Study to Prospectively Evaluate Reamed Intramedullary Nails in Patients with Tibial Fractures (SPRINT)

被引：18

作者：

Briel, Matthias ^{[1
,2
]}

Sprague, Sheila ^{[1
]}

Heels-Ansdell, Diane ^{[1
]}

Guyatt, Gordon ^{[1
]}

Bhandari, Mohit ^{[1
,3
]}

Blackhouse, Gordon ^{[1
,4
]}

Sanders, David ^{[5
]}

Schemitsch, Emil ^{[6
]}

Swiontkowski, Marc ^{[7
]}

Tornetta, Paul, III ^{[8
]}

Walter, Stephen D. ^{[1
]}

Goeree, Ron ^{[1
,4
]}

机构：

[1] McMaster Univ, Dept Clin Epidemiol & Biostat, Hamilton, ON, Canada

[2] Univ Basel Hosp, Inst Clin Epidemiol & Biostat, CH-4031 Basel, Switzerland

[3] McMaster Univ, Dept Surg, Hamilton, ON L8S 4L8, Canada

[4] St Josephs Healthcare Hamilton, PATH Res Inst, Hamilton, ON, Canada

[5] Univ Western Ontario, Dept Surg, London, ON N6A 3K7, Canada

[6] Univ Toronto, Dept Surg, Toronto, ON, Canada

[7] Univ Minnesota, Dept Orthopaed Surg, Med Ctr, Minneapolis, MN 55455 USA

[8] Boston Univ, Sch Med, Dept Orthoped Surg, Boston, MA 02118 USA

来源：

VALUE IN HEALTH | 2011年 / 14卷 / 04期

基金：

美国国家卫生研究院; 加拿大健康研究院;

关键词：

cost-utility analysis; economic analysis; reamed intramedullary nails; tibia fractures; unreamed intramedullary nails; SHAFT; MANAGEMENT;

D O I：

10.1016/j.jval.2010.10.034

中图分类号：

F [经济];

学科分类号：

020101 [政治经济学];

摘要：

Introduction: Recently, results from the large, randomized study to prospectively evaluate reamed intramedullary nails in patients with tibial fractures (SPRINT) trial suggested a benefit for reamed intramedullary nail insertion in patients with closed tibial shaft fractures largely based on cost-neutral autodynamizations and a potential advantage for unreamed intramedullary nailing in open fractures. We performed an economic evaluation to compare resource use and effectiveness of reamed and unreamed intramedullary nailing using a cost-utility analysis. Methods: We calculated quality-adjusted life years (QALYs) for each patient from a self-administered health utility index 3 questionnaire for the first 12 months following the intramedullary nailing. A convenience sample of 235 SPRINT patients provided data on costs associated with health care resource utilization. All costs are reported in Canadian dollars for the 2008 financial year. Results: We found incremental effects of -0.017 (95% confidence interval [CI] -0.021-0.058) and -0.002 (95% CI -0.060-0.062) QALYs for patients treated with reamed compared with unreamed intramedullary nails in closed and open fractures, respectively. The incremental costs for reamed compared with unreamed intramedullary nailing were $51 Canadian dollars (95% CI -$2298-$2400) in closed tibial fractures and $2546 Canadian dollars (95% CI -$1773-$6864) in open tibial fractures. Unreamed nailing dominated reamed nailing for both closed and open tibial fractures; however, the cost and the utility results had high variability. Conclusion: Our economic analysis from a governmental perspective suggests small differences in both cost and effectiveness with large uncertainty between reamed and unreamed intramedullary nailing.

引用

页码：450 / 457

页数：8

共 18 条

[1]

[Anonymous], ONTARIO DRUG BENEFIT

[2]

[Anonymous], PHYS SCHEDULE BENEFI

[3]

Treatment of open fractures of the shaft of the tibia - A systematic overview and meta-analysis [J].