A Cost/Utility Analysis of Open Reduction and Internal Fixation versus Cast Immobilization for Acute Nondisplaced Mid-Waist Scaphoid Fractures

Author(s): Davis EN, Chung KC, Kotsis SV, et al.

Source: Plastic & Reconstructive Surgery.  117: 1223-1235, 2006.


This study is a statistical cost/benefit analysis of casting versus ORIF with screw fixation for stable non-displaced mid-waist fractures of the scaphoid.  The study was conducted using 50 medical students, analyzing their preferences for either treatment modality in a time trade-off method.  The data for outcomes were extracted from the literature regarding treatment of scaphoid fractures.  Cost analysis for each modality was estimated using current Medicare reimbursement levels.  Estimates of lost productivity and wages were calculated using data from the US Bureau of Labor Statistics.  The results showed a greater benefit in quality-adjusted life years for surgical treatment in all age groups.  This benefit was greater in younger age groups.  Open reduction proved less costly to society across the board in all age groups.  This was especially true in calculating the cost of time off of work.

This interesting analysis attempts to isolate the quality of life benefits of two equally-accepted methods for treatment of non-displaced scaphoid waist fractures relative to the costs of each treatment modality, calculated in cost to society, both in dollars spent and productivity measures.  The results show statistically what most hand surgeons have understood empirically:  that surgical treatment is both individually more beneficial, with shorter healing times and faster recovery, and economically less costly.  Studies such as this should serve as useful data for insurers, as well as patients and surgeons, in determining the most efficacious methods of treatment for this common, and costly, injury.   It must be remembered, however, that truly non-displaced scaphoid fractures have an over 90% healing rate when treated conservatively.       

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