Cost effectiveness of surgical versus non-surgical treatment of adults with displaced fractures of the proximal humerus
The Bone & Joint Journal
Keywords Cost-effectiveness analysis, displaced fractures of the proximal humerus, within-trial economic evaluation, surgical treatment MREC (Multicentre Research Ethics Committee) approval was obtained from York Research Ethics Committee (reference number 08/H1311/12): Total word count 3,959 including body of the text and references. Abstract A pragmatic, multicentre randomised controlled trial (PROFHER) was conducted in United Kingdom (UK) National Health Service (NHS) hospitals to evaluate
... itals to evaluate the clinical effectiveness and cost-effectiveness of surgery compared with non-surgical treatment for displaced fractures of the proximal humerus involving the surgical neck in adults. A cost utility analysis from the NHS perspective was performed. Differences between surgical and non-surgical treatment groups in costs and quality adjusted life years (QALYs) at two years were used to derive an estimate of the cost-effectiveness of surgery using regression methods. Patients randomised to receive surgical intervention accumulated on average greater costs and marginally lower QALYs than patients randomised to non-surgery. The surgical intervention cost on average £1758 more per patient (95% CI £1126 to £2389). Total QALYs for the surgical group were smaller than those for non-surgery -0.0101 (95% CI -0.13 to 0.11). The probability of surgery being cost-effective was less than 10% given the current NICE willingness to pay threshold of £20 000 for an additional QALY. The results were robust to sensitivity analyses. The results suggest that current surgical treatment is not cost-effective for the majority of displaced fractures of the proximal humerus involving the surgical neck in the UK NHS. Sensitivity analysis iii: Including all resource use (shoulder and non-shoulder related), CC Sensitivity analysis iv: Source patient's questionnaires, MI Sensitivity analysis v: Source patient's questionnaires, CC * Difference between groups (surgery -not-surgery) and 95 per cent confidence intervals were estimated from bivariate model using seemingly unrelated regression. The covariates used to adjust for in the model were age, gender, treatment group, baseline utility and tuberosity involvement (yes/no) at baseline † Probability of surgery being cost-effective estimated by non-parametric bootstrapping.