Cost-utility analysis of cast compared to removable brace in the management of adult patients with ankle fractures.

Abstract

AIMS:

To compare the cost-utility of removable brace compared with cast in the management of adult patients with ankle fracture.

METHODS:

A within-trial economic evaluation conducted from the UK NHS and personnel social services (PSS) perspective. Health resources and quality-of-life data were collected as part of the Ankle Injury Rehabilitation (AIR) multicentre, randomized controlled trial over a 12-month period using trial case report forms and patient-completed questionnaires. Cost-utility analysis was estimated in terms of the incremental cost per quality adjusted life year (QALY) gained. Estimate uncertainty was explored by bootstrapping, visualized on the incremental cost-effectiveness ratio plane. Net monetary benefit and probability of cost-effectiveness were evaluated at a range of willingness-to-pay thresholds and visualized graphically.

RESULTS:

The incremental cost and QALYs of using brace over a 12-month period were £46.73 (95% confidence interval (CI) £-9 to £147) and 0.0141 (95% CI -0.005 to 0.033), respectively. The cost per QALY gained was £3,318. The probability of brace being cost-effective at a £30,000 per QALY willingness-to-pay threshold was 88%. The results remained robust to a range of sensitivity analyses.

CONCLUSION:

This within-trial economic evaluation found that it is probable that using a removable brace provides good value to the NHS when compared to cast, in the management of adults with ankle fracture. Cite this article: Bone Jt Open 2022;3(6):455-462.

• Authors: Henry Nwankwo, James Mason, Matthew L Costa, Nicholas Parsons, Anthony Redmond, Helen Parsons, Aminul Haque, Rebecca S Kearney
• Journal: Bone & joint open (Bone Jt Open) Vol. 3 Issue 6 Pg. 455-462 (Jun 2022) ISSN: 2633-1462 [Electronic] England
• PMID: 35658671 (Publication Type: Journal Article)