Skip to main content
Search
Search
Advanced Search
Skip main navigation
Open access
Research Article
17 April 2020

Impact of osteosynthesis in fracture care: a cost comparison study

Authors: Klaus Eichler https://orcid.org/0000-0002-6384-8223 [email protected], Marc Höglinger, Flurina Meier, Fabio Knöfler, Stefan M Scholz-Odermatt, Urs Brügger, Eberhard Denk, Felix Gutzwiller, Joachim Prein, Nikolaus Renner, and Alexander JoerisAuthor Info & Affiliations
Volume 9, Number 7
https://doi.org/10.2217/cer-2019-0194
PDFFormats

Abstract

Aim: To estimate the health economic impact of osteosynthesis (OS) in fracture care over six decades in 17 high-income countries. Patients & methods: Applying a decision tree model, we assumed a hypothetical absence of OS and compared OS (intervention) with conservative treatment (CONS; comparator). We included patients with femur, tibia and radius fractures (age <65 years) and for proximal femur fractures also elderly patients (≥70 years). Results: We estimated savings in direct and indirect costs of 855 billion Swiss francs in the working age population in addition to 4.6 million years of life gained. In the elderly population, 69 billion Swiss francs were saved in direct costs of proximal femur fractures in addition to 73 million years of life gained. Conclusion: OS contributed to maximize health gains of society.

Supplementary Material

File (suppl_file.docx)

References

Papers of special note have been highlighted as: • of interest; •• of considerable interest
1.
Schlich T. Surgery, Science and Industry: A Revolution in Fracture Care, 1950s–1990s. Palgrave Macmillan UK, London, UK (2002).
Google Scholar
• Provides a deeper understanding of the impact of osteosynthesis on patients, teaching, industry and science.
2.
Schlich T. Osteosynthese: geschichte einer schwierigen therapiemethode. In: Geschichte operativer Verfahren an den Bewegungsorganen. Rauschmann MA, Thomann K-D, Zichner L (Eds). Steinkopff Heidelberg, Heidelberg, Germany, 55–72 (2000).
Google Scholar
3.
Cutler DM, Long G, Berndt ER et al. The value of antihypertensive drugs: a perspective on medical innovation. Health Aff. 26(1), 97–110 (2007).
Google Scholar
4.
Turner S, Bhurke S, Cook A. Impact of NIHR HTA programme funded research on NICE clinical guidelines: a retrospective cohort. Health Res. Policy Syst. 13, 37 (2015).
PubMed
Google Scholar
5.
Guthrie S, Bienkowska-Gibbs T, Manville C, Pollitt A, Kirtley A, Wooding S. The impact of the National Institute for Health Research Health Technology programme, 2003–13: a multimethod evaluation. Health Technol. Assess. 19(67), 1–291 (2015).
PubMed
Google Scholar
6.
Guthrie S, Hafner M, Bienkowska-Gibbs T, Wooding S. Returns on research funded under the NIHR Health Technology Assessment (HTA) Programme. RAND Europe 1–83 (2015).
Google Scholar
7.
Central Office for Statistics in Accident Insurance. SSUV Statistik der Unfallversicherung UVG: medizinische Statistik (2017). www.unfallstatistik.ch/d/neuza/med_stat/med_stat_d.htm
Google Scholar
8.
Flikweert ER, Wendt KW, Diercks RL et al. Complications after hip fracture surgery: are they preventable? Eur. J. Trauma Emerg. Surg. 44(4), 573–580 (2018).
PubMed
Google Scholar
• Provides historical data on hip fracture mortality of the elderly population.
9.
Fixation Using Alternative Implants for the Treatment of Hip Fractures Investigators. Fracture fixation in the operative management of hip fractures (FAITH): an international, multicentre, randomised controlled trial. Lancet 389(10078), 1519–1527 (2017).
PubMed
Google Scholar
10.
Roberts SE, Goldacre MJ. Time trends and demography of mortality after fractured neck of femur in an English population, 1968–98: database study. BMJ 327(7418), 771–775 (2003).
PubMed
Google Scholar
• Provides historical data on hip fracture mortality of the elderly population.
11.
Dahl E. Mortality and life expectancy after hip fractures. Acta Orthop. Scand. 51(1), 163–170 (1980).
PubMed
Google Scholar
12.
Smith T, Hedges C, Macnair R, Schankat K, Wimhurst J. The clinical and radiological outcomes of the LISS plate for distal femoral fractures: a systematic review. Injury 40(10), 1049–1063 (2009).
PubMed
Google Scholar
13.
Mcnamara IR, Smith TO, Shepherd KL et al. Surgical fixation methods for tibial plateau fractures. Cochrane Database Syst. Rev. (9), CD009679 (2015).
PubMed
Google Scholar
14.
Scholz-Odermatt S. Veränderung der Unfallpyramide. Unfallstatistik UVG 2008-2012 Suva, Luzern, Switzerland, 71–79 (2012).
Google Scholar
15.
Clement ND, Beauchamp NJ, Duckworth AD, Mcqueen MM, Court-Brown CM. The outcome of tibial diaphyseal fractures in the elderly. Bone Joint J. 95-B(9), 1255–1262 (2013).
PubMed
Google Scholar
16.
Kuo LT, Chi C-C, Chuang C-H. Surgical interventions for treating distal tibial metaphyseal fractures in adults. Cochrane Database Syst. Rev. (3), CD010261 (2015).
PubMed
Google Scholar
17.
Kupperman ES, Kupperman AI, Mitchell SA. Treatment of radial head fractures and need for revision procedures at 1 and 2 years. J. Hand Surg. (Am.) 43(3), 241–247 (2018).
PubMed
Google Scholar
18.
Brugger U, Plessow R, Hess S et al. The health technology assessment of the compulsory accident insurance scheme of hand transplantation in Switzerland. J. Hand Surg. Eur. Vol. 40(9), 914–923 (2015).
PubMed
Google Scholar
19.
Bundesamt für Statistik, Medizinische Statistik der Krankenhäuser (2016). www.bfs.admin.ch/bfs/de/home/statistiken/gesundheit/erhebungen/ms.html
Google Scholar
20.
OECD Data (2018). https://data.oecd.org/
Google Scholar
• Provides country-specific data for estimation of international impact.
22.
Lyles KW, Colon-Emeric CS, Magaziner JS et al. Zoledronic acid and clinical fractures and mortality after hip fracture. N. Engl. J. Med. 357(18), 1799–1809 (2007).
PubMed
Google Scholar
23.
Suhm N, Kaelin R, Studer P et al. Orthogeriatric care pathway: a prospective survey of impact on length of stay, mortality and institutionalisation. Arch. Orthop. Trauma Surg. 134(9), 1261–1269 (2014).
PubMed
Google Scholar
25.
Gillespie WJ, Walenkamp GH. Antibiotic prophylaxis for surgery for proximal femoral and other closed long bone fractures. Cochrane Database Syst. Rev. (3), CD000244 (2010).
PubMed
Google Scholar
26.
Joeris A, Hoglinger M, Meier F et al. The impact of the AO Foundation on fracture care: an evaluation of 60 years AO Foundation. Injury 50(11), 1868–1875 (2019).
PubMed
Google Scholar
•• Provides a deeper understanding of the impact of osteosynthesis on patients, teaching, industry and science.
27.
Jeanneret J-P. Leading a Surgical Revolution. Springer Nature Switzerland AG, Cham, Switzerland (2019).
Google Scholar
28.
Piscitelli P, Brandi ML, Chitano G et al. Epidemiology of fragility fractures in Italy. Clin. Cases Miner. Bone Metab. 8(2), 29–34 (2011).
PubMed
Google Scholar
29.
Kannegaard PN, Van Der Mark S, Eiken P, Abrahamsen B. Excess mortality in men compared with women following a hip fracture. National analysis of comedications, comorbidity and survival. Age Ageing 39(2), 203–209 (2010).
PubMed
Google Scholar
• Provides recent data on hip fracture mortality of the elderly population.
30.
Page PR, Lord R, Jawad A et al. Changing trends in the management of intertrochanteric hip fractures – a single centre experience. Injury 47(7), 1525–1529 (2016).
PubMed
Google Scholar
31.
Imai N, Endo N, Shobugawa Y et al. A decrease in the number and incidence of osteoporotic hip fractures among elderly individuals in Niigata, Japan, from 2010 to 2015. J. Bone Miner. Metab. (2017) (Epub ahead of print).
Crossref
PubMed
Google Scholar
32.
Motisi M, Kurowicki J, Berglund DD et al. Trends in management of radial head and olecranon fractures. Open Orthop J 11, 239–247 (2017).
PubMed
Google Scholar
33.
Wieser S, Kauer L, Brügger U. Cost-benefit analysis of road accident prevention programmes in Switzerland from 1975 to 2007. (2009). file:///C:/Users/l.dormer/Downloads/01-2009-bericht-cba-road-accidents-e.pdf
Google Scholar
34.
Wieser S, Tomonaga Y, Riguzzi M et al. The cost of non-communicable diseases in Switzerland. (2014). www.zora.uzh.ch/id/eprint/103453/
Google Scholar
35.
Murray CJ, Barber RM, Foreman KJ. Global Burden of Disease Dalys Hale Collaborators. Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990–2013: quantifying the epidemiological transition. Lancet 386(10009), 2145–2191 (2015).
PubMed
Google Scholar
• Provides data on burden of disease due to injuries in countries of transition.
36.
Wennberg J, Gittelsohn A. Small area variations in health care delivery. Science 182(4117), 1102–1108 (1973).
PubMed
Google Scholar
37.
Caputo LM, Salottolo KM, Slone DS, Mains CW, Bar-Or D. The relationship between patient volume and mortality in American trauma centres: a systematic review of the evidence. Injury 45(3), 478–486 (2014).
PubMed
Google Scholar
38.
Schweizerische Akademie Der Medizinischen Wissenschaften. Stärkung der Versorgungsforschung in der Schweiz. Swiss Academic Reports 9(1), 1–59 (2014).
Google Scholar
39.
Porter M, Teisberg E. Redefining Health Care. Creating Value-Based Competition on Results. Harvard Business School Press, MA, USA (2006).
Google Scholar
40.
World Health Organization Global emergency and trauma care initiative (2019). www.who.int/emergencycare/global-initiative/en/
Google Scholar
• A recent WHO initiative to tackle burden of disease due to injuries in countries of transition.
|