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Economics Analysis of Open Versus Closed Treatment for Distal Radius Fractures
BaiJing Qin, MD
University of Massachusetts Medical School, Worcester, MA

Introduction: Distal radius fracture (DRFx) is the most common upper extremity fracture in the United States and thus poses a significant loss of productivity. In this economic model, cost effectiveness of distal radius fracture treatment with open reduction internal fixation (ORIF) is compared to closed treatment with casting. The length of temporary disability due to the fracture depends on the treatment options. The theoretical gain in productivity with the open treatment not only justifies the differential cost of treatment for the individual patient, but benefits society as a whole as well.
Materials & Methods: The quality-adjusted life-year (QALY) is used in estimating quality of life benefits in this economic evaluation. Three groups of subjects are analyzed: youth (age <21), workforce (age 21-65), and retired (age >65). Their QALY's from open versus closed treatments are compared based on age-stratified health-related quality of life (HRQoL). The differential cost between ORIF and closed treatment is calculated for extra-articular, intra-articular simple, and intra-articular complex fractures. Cost effectiveness of treatment type varies by occupation-based annual income (I).
Results: Closed treatment for DRFx requires patients to be immobile for 5 more weeks than ORIF. Ceteris paribus, closed treatment costs 0.096, 0.087, and 0.082 more QALYs for the youth, workforce, and retired group, respectively. Open treatment is more expensive than closed treatment, and the differential cost (E) between them for extra-articular, intra-articular simple, and intra-articular complex fractures is $1561, $1992, and $2931. The cost effectiveness model can be defined as X = QALY x I E. The majority of patients in the workforce has a net financial benefit from open reduction in all types of DRFxs (Table 1). The minimum income to receive a net benefit from open reduction is $16,234 for extra-articular, $23,019 for intra-articular simple, and $35,862 for intra-articular complex fractures.
Table 1. Cost benefit of DRFx open treatment.

Conclusion: Open treatment for DRFx lessens the burden due to the loss of productivity from immobilization and provides more QALYs compared to closed treatment. There is economic incentive to encourage open treatment for this common fracture for our patients and for our society.


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