Cost effectiveness of surgical versus non-surgical treatment of adults with displaced fractures of the proximal humerus: economic evaluation alongside the PROFHER trial

Hdl Handle:
http://hdl.handle.net/10149/595876
Title:
Cost effectiveness of surgical versus non-surgical treatment of adults with displaced fractures of the proximal humerus: economic evaluation alongside the PROFHER trial
Authors:
Corbacho, B.; Duarte, A.; Keding, A. (Ada); Handoll, H. H. G. (Helen); Chuang, L. H. (Ling-Hsiang); Torgerson, D. (David); Brealey, S. (Stephen); Jefferson, L. (Laura); Hewitt, C. (Catherine); Rangan, A. (Amar)
Affiliation:
Teesside University. Health and Social Care Institute
Citation:
Corbacho, B., Duarte, A., Keding, A., Handoll, H., Chuang, L. H., Torgerson, D., Brealey, S., Jefferson, L., Hewitt, C., Rangan, A. (2016) 'Cost effectiveness of surgical versus nonsurgical treatment of adults with displaced fractures of the proximal humerus. Economic evaluation alongside the PROFHER TRIAL' Bone and Joint Journal; 98-B:2:152-9
Publisher:
British Editorial Society of Bone and Joint Surgery
Journal:
The Bone & Joint Journal
Issue Date:
5-Feb-2016
URI:
http://hdl.handle.net/10149/595876
DOI:
10.1302/0301-620X.98B2.36614
Additional Links:
http://www.bjj.boneandjoint.org.uk/cgi/doi/10.1302/0301-620X.98B2.36614
Abstract:
Aims A pragmatic multicentre randomised controlled trial (PROFHER) was conducted in United Kingdom National Health Service (NHS) hospitals 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. Methods 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. Results Patients randomised to receive surgical intervention accumulated mean greater costs and marginally lower QALYs than patients randomised to non-surgery. The surgical intervention cost a mean of £1758 more per patient (95% confidence intervals (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 at a threshold of £20 000 for an additional QALY. The results were robust to sensitivity analyses. Discussion 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 United Kingdom’s NHS. Take home message: The results of this trial do not support the trend of increased surgical treatment for patients with displaced fractures of the proximal humerus involving the surgical neck within the United Kingdom NHS.
Type:
Article
Language:
en
ISSN:
2049-4394
Rights:
Author can archive post-print (ie final draft post-refereeing) without embargo. For full details see http://www.sherpa.ac.uk/romro [Accessed: 08/02/2016]

Full metadata record

DC FieldValue Language
dc.contributor.authorCorbacho, B.en
dc.contributor.authorDuarte, A.en
dc.contributor.authorKeding, A. (Ada)en
dc.contributor.authorHandoll, H. H. G. (Helen)en
dc.contributor.authorChuang, L. H. (Ling-Hsiang)en
dc.contributor.authorTorgerson, D. (David)en
dc.contributor.authorBrealey, S. (Stephen)en
dc.contributor.authorJefferson, L. (Laura)en
dc.contributor.authorHewitt, C. (Catherine)en
dc.contributor.authorRangan, A. (Amar)en
dc.date.accessioned2016-02-08T11:26:19Zen
dc.date.available2016-02-08T11:26:19Zen
dc.date.issued2016-02-05en
dc.identifier.citationThe Bone & Joint Journal; 98-B (2):152en
dc.identifier.issn2049-4394en
dc.identifier.doi10.1302/0301-620X.98B2.36614en
dc.identifier.urihttp://hdl.handle.net/10149/595876en
dc.description.abstractAims A pragmatic multicentre randomised controlled trial (PROFHER) was conducted in United Kingdom National Health Service (NHS) hospitals 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. Methods 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. Results Patients randomised to receive surgical intervention accumulated mean greater costs and marginally lower QALYs than patients randomised to non-surgery. The surgical intervention cost a mean of £1758 more per patient (95% confidence intervals (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 at a threshold of £20 000 for an additional QALY. The results were robust to sensitivity analyses. Discussion 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 United Kingdom’s NHS. Take home message: The results of this trial do not support the trend of increased surgical treatment for patients with displaced fractures of the proximal humerus involving the surgical neck within the United Kingdom NHS.en
dc.language.isoenen
dc.publisherBritish Editorial Society of Bone and Joint Surgeryen
dc.relation.urlhttp://www.bjj.boneandjoint.org.uk/cgi/doi/10.1302/0301-620X.98B2.36614en
dc.rightsAuthor can archive post-print (ie final draft post-refereeing) without embargo. For full details see http://www.sherpa.ac.uk/romro [Accessed: 08/02/2016]en
dc.titleCost effectiveness of surgical versus non-surgical treatment of adults with displaced fractures of the proximal humerus: economic evaluation alongside the PROFHER trialen
dc.typeArticleen
dc.contributor.departmentTeesside University. Health and Social Care Instituteen
dc.identifier.journalThe Bone & Joint Journalen
or.citation.harvardCorbacho, B., Duarte, A., Keding, A., Handoll, H., Chuang, L. H., Torgerson, D., Brealey, S., Jefferson, L., Hewitt, C., Rangan, A. (2016) 'Cost effectiveness of surgical versus nonsurgical treatment of adults with displaced fractures of the proximal humerus. Economic evaluation alongside the PROFHER TRIAL' Bone and Joint Journal; 98-B:2:152-9en
dc.eprint.versionPost-printen
dc.embargoNoneen
dc.date.accepted2015-09-25en
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