Cost effectiveness analysis of operative versus nonoperative management of humeral shaft fractures in Denmark

PURPOSE: This study aims to compare the cost-effectiveness of operative versus nonoperative management in the Danish healthcare system.

METHODS: A decision tree model for treatment options was developed. We used DRG fees and expert opinion to determine the total treatment cost in our institution. Mean wages-included as a component of cost during the time from work-and weeks missed were obtained from Statistics Denmark and the existing literature. The DASH survey, used to determine treatment efficacy, was also extracted from existing literature. An economic evaluation was conducted by use of rollback analysis and Monte Carlo simulation. The results were presented in cost ($) per meaningful change in DASH score. The Willingness-to-Pay threshold was set at $43,478.

RESULTS: Operative management was identified as the preferred treatment option from a cost-effectiveness perspective: it is both more effective and less costly to the patient at both 6-month and 1-year follow-up when including lost wages. Sensitivity analyses show that even when non-operative success is increased to 100%, operative management remained cost-effective at both 6 months and 1-year follow-up in our wage loss-inclusive model. Nonoperative treatment is only more cost-effective than operative treatment at or above 97.6% union rate at 1-year follow-up in our model that excluded wage loss as a component of cost.

CONCLUSION: Operative management is cost-effective at both 6 months and 1 year, compared to non-operative treatment, when including wage loss as a component of cost.

LEVEL OF EVIDENCE: Economic and Decision Analysis Level II.