Cost-effectiveness analysis of total elbow arthroplasty versus open reduction-internal fixation for distal humeral fractures.
BACKGROUND
Total elbow arthroplasty (TEA) and open reduction-internal fixation (ORIF) are 2 viable surgical treatment options for acute, intra-articular distal humeral fractures in elderly patients. Whereas recent systematic reviews and randomized trials have suggested that TEA and ORIF result in similar functional outcome scores, no previous study has assessed the comparative cost-effectiveness between TEA and distal humeral ORIF in this specific demographic.


METHODS
A Markov model was created with the highest-level data available from the literature depicting transitioning health states based on treatment strategies. To populate the quality-of-life data points in the model lacking in the literature, a survey was conducted of patients at 2 referral institutions who underwent TEA or ORIF for acute, intra-articular distal humeral fractures via the European Quality of Life, 5 Domains (EQ-5D) questionnaire at least 2 years postoperatively. Cost data from 2016 for each strategy were used to calculate the comparative cost-effectiveness of TEA versus ORIF.


RESULTS
For patients aged 65 years, the total cost of TEA was $19,407 compared with $20,669 for ORIF. The effectiveness of TEA and ORIF was 8.17 and 7.72, respectively. Overall, the incremental cost-effectiveness ratio of TEA ($2375.76/quality-adjusted life-year) was favored more than ORIF ($2677.26/quality-adjusted life-year).


CONCLUSION
These findings suggest TEA is a slightly more cost-effective procedure than ORIF for most elderly patients who sustain acute, intra-articular distal humeral fractures. Still, the unique limitations, complications, and revision rates for each strategy must be carefully weighed for each patient when making a decision.
['Federer|Andrew E|AE|', 'Mather|Richard C|RC|', 'Ramsey|Matthew L|ML|', 'Garrigues|Grant E|GE|']
D000368:Aged D000369:Aged, 80 and over D057929:Arthroplasty, Replacement, Elbow D003362:Cost-Benefit Analysis D005260:Female D005593:Fracture Fixation, Internal D006801:Humans D006810:Humeral Fractures D008297:Male D008875:Middle Aged D000070799:Open Fracture Reduction D011788:Quality of Life D019057:Quality-Adjusted Life Years D012189:Retrospective Studies D016896:Treatment Outcome
cost-effectiveness analysis Total elbow arthroplasty distal humeral fracture Markov model incremental cost-effectiveness ratio open reduction–internal fixation