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. 2022 Jun;106(2):169-177.
doi: 10.1007/s12306-020-00687-3. Epub 2020 Nov 19.

Cost-effectiveness of introducing cone-beam computed tomography (CBCT) in the management of complex phalangeal fractures: economic simulation

N Faccioli  1 , E Santi  2 , G Foti  3 , G Mansueto  2 , M Corain  4
Affiliations

Cost-effectiveness of introducing cone-beam computed tomography (CBCT) in the management of complex phalangeal fractures: economic simulation

N Faccioli et al. Musculoskelet Surg. 2022 Jun.

Abstract

Purpose: The purpose of this study was to evaluate the cost-effectiveness of introducing cone-beam computed tomography (CBCT) in the management of the complex finger fractures with articular involvement.

Methods: We created a decision tree model simulating the diagnostic pathway of complex finger fractures, suggesting the use of CBCT as alternative to multi-slice computed tomography (MSCT), and we compared their clinical outcomes, costs, and cost-effectiveness for a hypothetical cohort of 10,000 patients. Measures of effectiveness are analysed by using quality-adjusted life years, incremental cost-effectiveness ratio, and net monetary benefit.

Results: Diagnosis of a complex finger fracture performed with CBCT costed 67.33€ per patient, yielded 9.08 quality-adjusted life years, and gained an incremental cost-effectiveness ratio of 29.94€ and a net monetary benefit of 9.07 € at 30,000€ threshold. Using MSCT for diagnosis costed 106.23 €, yielded 8.18 quality-adjusted life years, and gained an incremental cost-effectiveness ratio of 371.15 € and a net monetary benefit of 8.09 €. CBCT strategy dominated the MSCT strategy. The acceptability curve shows that there is 98% probability of CBCT being the optimal strategy at 30,000€ threshold (1 EUR equal to 1.11 USD; updated on 02/02/2020).

Conclusion: CBCT in complex finger fractures management is cost saving compared with MSCT and may be considered a valuable imaging tool in preoperative assessment, allowing early detection and appropriate treatment. It shortens the time to completion of diagnostic work-up, reduces the number of additional diagnostic procedures, improves quality of life, and may reduce costs in a societal perspective.

Keywords: Complex phalangeal fractures; Cone-beam computed tomography; Cost-effectiveness; Finger; Multi-slice computed tomography.

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Conflict of interest statement

Authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Decisional tree for management strategies in finger fracture
Fig. 2
Fig. 2
One-way analysis plot for the decision “Diagnosis”. The black horizontal line denotes the expected utility in the reference case. The red line denotes the effectiveness of MSCT, the blue line the effectiveness of CBCT, and the green line the effectiveness without CT. Effectiveness results 8.18 for MSCT and 9.08 for CBCT; the latter is the best choice
See this image and copyright information in PMC

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