# Cost-effectiveness of cast treatment vs. surgery in elderly patients with substantially displaced intra-articular distal radius fractures: A trial-based economic evaluation

## TL;DR

This study compares the cost-effectiveness of cast treatment versus surgery for elderly patients with wrist fractures, finding that surgery may be more beneficial despite higher initial costs.

## Contribution

The study provides new evidence on the cost-effectiveness of surgical versus cast treatment for elderly patients with displaced wrist fractures.

## Key findings

- Surgery resulted in improved wrist function and slightly higher quality-adjusted life years compared to cast treatment.
- The incremental cost-effectiveness ratio favored surgery with €15 per PRWE point improvement and €2070 per QALY gained.
- Cast treatment had lower direct costs but higher informal and secondary care costs, making surgery more favorable from a societal perspective.

## Abstract

The number of surgical procedures for distal radius fractures in the elderly has increased, even though most studies show little or no benefit over cast treatment. While medical costs of surgical treatment are higher than those of cast treatment, surgery may enable faster recovery and help patients maintain independence, potentially reducing their use of other healthcare resources and informal care.

We evaluated whether cast treatment is cost-effective compared to surgery for patients aged 65 years or older with substantially displaced intra-articular distal radius fractures. A multicentre randomized controlled non-inferiority trial with an economic evaluation in 19 hospitals in the Netherlands. Participants completed (cost) questionnaires at baseline, 3, 6, 9 and 12 months after trauma. A total of 138 patients were randomized between cast treatment and surgery. Health-related quality of life was measured with the EQ-5D-3L; wrist function was measured with the Patient Rated Wrist Evaluation (PRWE). Costs were assessed from a societal perspective, including intervention costs, healthcare use, informal care, unpaid productivity losses, and patients’ own expenses.

The estimated difference in total societal costs was -€81 (95%CI -€3936 to €3773) in favour of cast treatment compared with surgical treatment. Compared with cast treatment, surgery resulted in improved wrist function (PRWE: −5.5; 95% CI: −10 to −0.7) and slightly higher QALYs (+0.039; 95%CI 0.012 to 0.066), equivalent to 14 days in perfect health. The incremental cost-effectiveness ratio was €15 per point improvement in PRWE and €2070 per QALY gained. Cast treatment’s probability of cost-effectiveness was low for all values of willingness to pay.

Although cast treatment had lower direct costs, these were offset by higher informal and secondary care costs. Surgical treatment offered clinically relevant short-term benefits. From a societal perspective, surgery appears to be the more favorable option for elderly patients with displaced distal radius fractures.