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Randomized Controlled Trial
. 2025 Dec;26(9):1645-1654.
doi: 10.1007/s10198-025-01795-2. Epub 2025 Jun 2.

One week versus three to five weeks of plaster cast immobilization for nonreduced distal radius fractures, a cost effectiveness analysis embedded in a stepped wedge cluster randomized controlled trial

Marcel A N de Bruijn  1 , Emily Z Boersma  2 , Lysanne van Silfhout  2 , Tjarda N Tromp  2 , Eddy M M Adang  3 , Erik van de Krol  2 , Michael J R Edwards  2 , Vincent M A Stirler  2 , Erik Hermans  2 ; Cast-O.F.F. 2 study group
Collaborators, Affiliations
Randomized Controlled Trial

One week versus three to five weeks of plaster cast immobilization for nonreduced distal radius fractures, a cost effectiveness analysis embedded in a stepped wedge cluster randomized controlled trial

Marcel A N de Bruijn et al. Eur J Health Econ. 2025 Dec.

Abstract

Objective: Distal radius fractures are commonly seen at the Emergency Department. In the Netherlands, non- or minimally displaced fractures are immobilized for 3-5 weeks. However, evidence suggests shorter immobilization yields similar or better functional outcome. There is a lack of cost-effectiveness studies investigating shorter duration of cast immobilization. This study investigates the cost-effectiveness of one week of plaster cast immobilization versus three to five weeks.

Methods: Cost-effectiveness data was collected as part of the Cast-OFF 2 study which started the 1st of January 2022. A randomized stepped wedge cluster design was used with 11 hospitals, and 10 clusters, including patients with an isolated non- or minimally displaced distal radius fracture without fracture reduction. Costs on medical consumption, and productivity were scored with the local Electronical Patient Record, and questionnaires at week one, six, month six, and twelve. Cost-effectiveness was reported per Quality-Adjusted Life Year (QALY).

Results: A total of 402 patients were included (control n = 197 vs intervention n = 205). No differences in QALY were observed (+ 0.02, CI [-0.02, 0.06]). Cost savings for the intervention group ranged from €31.94 to €322.41 depending on different scenarios. The future perspective scenario with reduction of one outpatient clinic visit showed a significant cost saving of €254.27 (CI [-467.33, -41.21]). No significant differences were observed in baseline characteristics.

Conclusion: One week of plaster cast immobilization for non- or minimally displaced distal radius fractures results in comparable or better cost savings compared to usual care. Adopting one week of cast immobilization as the new standard-of-care could reduce healthcare costs.

Trial registration: Netherlands Trial Register NL9278. CMO: 2-21-7308.

Keywords: Cast immobilization; Conservative treatment; Cost effectiveness analysis; Distal radius fractures; Trauma.

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Conflict of interest statement

Declarations. Conflict of interest: The first author received a research grant from the Osteosynthesis and Trauma Care Foundation (OTCF) and Orthopaedic Trauma Association (OTA) as part of a PhD-project. All authors declare no potential conflicts of interest. Ethical approval: This study did not fall within the remit of a Medical Research Involving Human Subjects Act (WMO) study, as reviewed by the Commissie Mensgebonden Onderzoek (CMO) Arnhem-Nijmegen and therefor did not need approval from the Dutch Ethical Review Board (METC) Arnhem-Nijmegen. JEL code: I20 Note: The study was performed at the Radboud University Medical Center, Nijmegen, the Netherlands.

Figures

Fig. 1
Fig. 1
CONSORT FLOW diagram. Number of patients screened, included, lost to follow-up and analyzed. *Lost of follow-up due to withdrawal from study or no reasons given
Fig. 2
Fig. 2
Cost-effectiveness plane. Cost-effectiveness plane for the societal perspective scenario showing differences in societal costs, and effect of intervention in quality adjusted life years (QALY). In the upper right quadrant, the intervention is more expensive and more effective, in the upper left quadrant more expensive and less effective, in the lower left quadrant the intervention is less expensive and less effective, in the lower right quadrant less expensive and more effective. Values between the red and blue line indicate the 95% confidence interval
Fig. 3
Fig. 3
Cost-effectiveness acceptability curve. Cost-effectiveness acceptability curve showing the probability of one week of cast immobilization being cost-effective for different values of willingness to pay for a QALY gained
See this image and copyright information in PMC

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