Cost-effectiveness analysis of locking nail compared with locking plate for displaced 3- and 4-part proximal humerus fractures: a secondary analysis of a randomized trial comparing the Multiloc nail and PHILOS plate
DOI:
https://doi.org/10.2340/17453674.2025.44881Keywords:
Fractures, Orthopaedic trauma, RCT, ShoulderAbstract
Background and purpose: Previous studies show no clear difference in functional outcomes between locking nails and plates for proximal humerus fractures (PHFs). Economic evaluations provide valuable insights into cost-effectiveness to guide healthcare decisions. We aimed to conduct a cost-effectiveness analysis based on a semidouble-blinded randomized controlled trial comparing nailing and plating for displaced 3- and 4-part PHFs with 2-year follow-up.
Methods: 79 patients with displaced 3- or 4-part PHFs were randomized to undergo open reduction and internal fixation using either a nail or a plate. Patients were followed for 2 years, with costs tracked for the index surgery, hospital stay, additional healthcare services, and secondary procedures. Quality-adjusted life years (QALYs) were calculated using EQ-5D, and incremental cost-effectiveness ratios (ICERs) were used to compare treatments.
Results: 38 patients in each group were eligible for analysis. Mean total costs were €21,654 (standard deviation [SD] 10,448) for nails and €16,374 (SD 3,886) for plates, with a mean difference of €5,296 (95% confidence interval [CI] 1,989–8,603). Extra costs for reoperations and other non-regular follow-ups were €3,746 (SD 10,448) for nails and €265, (SD 1,217) for plates, resulting in a mean difference of €3,480 (CI –868 to 7,829) extra costs for nails. The mean QALY showed no statistical difference between groups of 0.09 (CI –0.003 to 0.17) (1.65 in the nail group and 1.74 in the plate group).
Conclusion: Plates were more cost-effective compared with nails but did not result in a statistically significant difference in QALY.
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Copyright (c) 2025 Annette Konstanse Bordewich Wikerøy, Per-Henrik Randsborg, Eline Aas, Hendrik Frølich Stange Fuglesang, Rune Bruhn JAKOBSEN Jakobsen
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