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Randomized Controlled Trial
. 2024 Jun 1;106-B(6):623-630.
doi: 10.1302/0301-620X.106B6.BJJ-2023-1211.R1.

Cost-effectiveness analysis of soft bandage and immediate discharge versus rigid immobilization in children with distal radius torus fractures

Daniel C Perry  1   2   3 , Melina Dritsaki  4   5 , Juul Achten  3 , Duncan Appelbe  3 , Ruth Knight  6   7 , James Widnall  2 , Damian Roland  8 , Shrouk Messahel  2 , Matthew L Costa  3 , James Mason  9 ; FORCE Collaborators in association with PERUKI; FORCE COLLABORATORS IN ASSOCIATION WITH PERUKI; Rahail Ahmad, Anastasia Alcock, Andrew Appelboam, Lisa Armour, Jane Bayreuther, Rhys Beynon, Charlotte Brown, Emily Cadman, Louise Conner, Nadine Darlow, Tessa Davis, Phoebe Gibson, Colin Gilhooley, Sylvester Gomes, Christopher Gough, David Hartin, Stuart Hartshorn, Temem Hussan, Neha Jain, Emma Jenkinson, Graham Johnson, Lisa Kehler, Matthew Long, Mark Lyttle, Shahab Manouchehri, Christopher McKie, David Metcalfe, Fergal Monsell, Louise Morgans, Niall Mullen, Nicolas Nicolaou, Alex Novak, Catherine Nunn, Kath O'Hagan, Aman Paul, Jennifer Preston, Shammi Ramlakhan, Aarani Somaskanthan, Yok W Tan, Manish Thakker, Krishna Vemulapalli, Joanna Weekes, Daniel Westacott, Sarah Wilson, Darryl Wood
Affiliations
Randomized Controlled Trial

Cost-effectiveness analysis of soft bandage and immediate discharge versus rigid immobilization in children with distal radius torus fractures

Daniel C Perry et al. Bone Joint J. .

Abstract

Aims: The aim of this trial was to assess the cost-effectiveness of a soft bandage and immediate discharge, compared with rigid immobilization, in children aged four to 15 years with a torus fracture of the distal radius.

Methods: A within-trial economic evaluation was conducted from the UK NHS and personal social services (PSS) perspective, as well as a broader societal point of view. Health resources and quality of life (the youth version of the EuroQol five-dimension questionnaire (EQ-5D-Y)) data were collected, as part of the Forearm Recovery in Children Evaluation (FORCE) multicentre randomized controlled trial over a six-week period, using trial case report forms and patient-completed questionnaires. Costs and health gains (quality-adjusted life years (QALYs)) were estimated for the two trial treatment groups. Regression was used to estimate the probability of the new treatment being cost-effective at a range of 'willingness-to-pay' thresholds, which reflect a range of costs per QALY at which governments are typically prepared to reimburse for treatment.

Results: The offer of a soft bandage significantly reduced cost per patient (saving £12.55 (95% confidence interval (CI) -£5.30 to £19.80)) while QALYs were similar (QALY difference between groups: 0.0013 (95% CI -0.0004 to 0.003)). The high probability (95%) that offering a bandage is a cost-effective option was consistent when examining the data in a range of sensitivity analyses.

Conclusion: In addition to the known clinical equivalence, this study found that the offer of a bandage reduced cost compared with rigid immobilization among children with a torus fracture of the distal radius. While the cost saving was small for each patient, the high frequency of these injuries indicates a significant saving across the healthcare system.

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Conflict of interest statement

This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (17/23/02). D. C. Perry was funded through an NIHR Clinician Scientist Fellowship (CS-2014–14–012) and latterly an NIHR Research Professorship. The trial was supported by the NIHR Oxford Biomedical Research Centre. The University of Oxford acted as the study Sponsor. J. Achten and M. L. Costa's employer, The University of Oxford, receives research funding from the NIHR and Wellcome Trust for research into musculoskeletal trauma. S. Messahel holds a voluntary position as Secretary of the Executive Committee of Paediatric Emergency Research UK and Ireland Network.

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