Economic evaluation of reamed versus unreamed intramedullary nailing in patients with closed and open tibial fractures: Results from the study to prospectively evaluate reamed intramedullary nails in patients with tibial fractures (SPRINT)

Matthias Briel; Sheila Sprague; Diane Heels-Ansdell; Gordon Guyatt; Mohit Bhandari; Gordon Blackhouse; David Sanders; Emil Schemitsch; Marc Swiontkowski; Paul Tornetta; Stephen D. Walter; Ron Goeree

doi:10.1016/j.jval.2010.10.034

Economic evaluation of reamed versus unreamed intramedullary nailing in patients with closed and open tibial fractures: Results from the study to prospectively evaluate reamed intramedullary nails in patients with tibial fractures (SPRINT)

Matthias Briel, Sheila Sprague, Diane Heels-Ansdell, Gordon Guyatt, Mohit Bhandari, Gordon Blackhouse, David Sanders, Emil Schemitsch, Marc Swiontkowski, Paul Tornetta, Stephen D. Walter, Ron Goeree

Orthopaedic Surgery

Research output: Contribution to journal › Article › peer-review

15 Scopus citations

Abstract

Introduction: Recently, results from the large, randomized study to prospectively evaluate reamed intramedullary nails in patients with tibial fractures (SPRINT) trial suggested a benefit for reamed intramedullary nail insertion in patients with closed tibial shaft fractures largely based on cost-neutral autodynamizations and a potential advantage for unreamed intramedullary nailing in open fractures. We performed an economic evaluation to compare resource use and effectiveness of reamed and unreamed intramedullary nailing using a cost-utility analysis. Methods: We calculated quality-adjusted life years (QALYs) for each patient from a self-administered health utility index 3 questionnaire for the first 12 months following the intramedullary nailing. A convenience sample of 235 SPRINT patients provided data on costs associated with health care resource utilization. All costs are reported in Canadian dollars for the 2008 financial year. Results: We found incremental effects of -0.017 (95% confidence interval [CI] -0.021-0.058) and -0.002 (95% CI -0.060-0.062) QALYs for patients treated with reamed compared with unreamed intramedullary nails in closed and open fractures, respectively. The incremental costs for reamed compared with unreamed intramedullary nailing were $51 Canadian dollars (95% CI -$2298-$2400) in closed tibial fractures and $2546 Canadian dollars (95%CI -$1773-$6864) in open tibial fractures. Unreamed nailing dominated reamed nailing for both closed and open tibial fractures; however, the cost and the utility results had high variability. Conclusion: Our economic analysis from a governmental perspective suggests small differences in both cost and effectiveness with large uncertainty between reamed and unreamed intramedullary nailing.

Original language	English (US)
Pages (from-to)	450-457
Number of pages	8
Journal	Value in Health
Volume	14
Issue number	4
DOIs	https://doi.org/10.1016/j.jval.2010.10.034
State	Published - Jun 2011

Bibliographical note

Funding Information:
Source of financial support: The SPRINT study was funded by research grants from the Canadian Institutes of Health Research # MCT-38140 [PI: G.G.], National Institutes of Health NIAMS-072 ; R01 AR48529 [PI: M.S.], Orthopaedic Research and Education Foundation [PI: P.T.], Orthopaedic Trauma Association [PI: M. Bhandari]. Smaller site-specific grants were also obtained from Hamilton Health Sciences Research Grant [PI: M. Bhandari] and Zimmer [PI: M. Bhandari]. Dr. Briel was supported by the Swiss National Foundation [PASMA-112951/1] and the Roche Research Foundation. Dr. Bhandari is funded, in part, by a Canada Research Chair in Musculoskeletal Trauma, McMaster University. The SPRINT Economic Analysis was funded by a grant from the Orthopaedic Research and Education Foundation [PI: W. Creevy]. Trial Registration: Clinicaltrial.gov identifier: NCT00038129 http://www.clinicaltrials.gov .

Keywords

Cost-utility analysis
Economic analysis
Reamed intramedullary nails
Tibia fractures
Unreamed intramedullary nails

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Briel, M., Sprague, S., Heels-Ansdell, D., Guyatt, G., Bhandari, M., Blackhouse, G., Sanders, D., Schemitsch, E., Swiontkowski, M., Tornetta, P., Walter, S. D., & Goeree, R. (2011). Economic evaluation of reamed versus unreamed intramedullary nailing in patients with closed and open tibial fractures: Results from the study to prospectively evaluate reamed intramedullary nails in patients with tibial fractures (SPRINT). Value in Health, 14(4), 450-457. https://doi.org/10.1016/j.jval.2010.10.034

Economic evaluation of reamed versus unreamed intramedullary nailing in patients with closed and open tibial fractures: Results from the study to prospectively evaluate reamed intramedullary nails in patients with tibial fractures (SPRINT). / Briel, Matthias; Sprague, Sheila; Heels-Ansdell, Diane et al.
In: Value in Health, Vol. 14, No. 4, 06.2011, p. 450-457.

Research output: Contribution to journal › Article › peer-review

Briel, M, Sprague, S, Heels-Ansdell, D, Guyatt, G, Bhandari, M, Blackhouse, G, Sanders, D, Schemitsch, E, Swiontkowski, M, Tornetta, P, Walter, SD & Goeree, R 2011, 'Economic evaluation of reamed versus unreamed intramedullary nailing in patients with closed and open tibial fractures: Results from the study to prospectively evaluate reamed intramedullary nails in patients with tibial fractures (SPRINT)', Value in Health, vol. 14, no. 4, pp. 450-457. https://doi.org/10.1016/j.jval.2010.10.034

Briel M, Sprague S, Heels-Ansdell D, Guyatt G, Bhandari M, Blackhouse G et al. Economic evaluation of reamed versus unreamed intramedullary nailing in patients with closed and open tibial fractures: Results from the study to prospectively evaluate reamed intramedullary nails in patients with tibial fractures (SPRINT). Value in Health. 2011 Jun;14(4):450-457. doi: 10.1016/j.jval.2010.10.034

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title = "Economic evaluation of reamed versus unreamed intramedullary nailing in patients with closed and open tibial fractures: Results from the study to prospectively evaluate reamed intramedullary nails in patients with tibial fractures (SPRINT)",

abstract = "Introduction: Recently, results from the large, randomized study to prospectively evaluate reamed intramedullary nails in patients with tibial fractures (SPRINT) trial suggested a benefit for reamed intramedullary nail insertion in patients with closed tibial shaft fractures largely based on cost-neutral autodynamizations and a potential advantage for unreamed intramedullary nailing in open fractures. We performed an economic evaluation to compare resource use and effectiveness of reamed and unreamed intramedullary nailing using a cost-utility analysis. Methods: We calculated quality-adjusted life years (QALYs) for each patient from a self-administered health utility index 3 questionnaire for the first 12 months following the intramedullary nailing. A convenience sample of 235 SPRINT patients provided data on costs associated with health care resource utilization. All costs are reported in Canadian dollars for the 2008 financial year. Results: We found incremental effects of -0.017 (95% confidence interval [CI] -0.021-0.058) and -0.002 (95% CI -0.060-0.062) QALYs for patients treated with reamed compared with unreamed intramedullary nails in closed and open fractures, respectively. The incremental costs for reamed compared with unreamed intramedullary nailing were $51 Canadian dollars (95% CI -$2298-$2400) in closed tibial fractures and $2546 Canadian dollars (95%CI -$1773-$6864) in open tibial fractures. Unreamed nailing dominated reamed nailing for both closed and open tibial fractures; however, the cost and the utility results had high variability. Conclusion: Our economic analysis from a governmental perspective suggests small differences in both cost and effectiveness with large uncertainty between reamed and unreamed intramedullary nailing.",

keywords = "Cost-utility analysis, Economic analysis, Reamed intramedullary nails, Tibia fractures, Unreamed intramedullary nails",

author = "Matthias Briel and Sheila Sprague and Diane Heels-Ansdell and Gordon Guyatt and Mohit Bhandari and Gordon Blackhouse and David Sanders and Emil Schemitsch and Marc Swiontkowski and Paul Tornetta and Walter, {Stephen D.} and Ron Goeree",

note = "Funding Information: Source of financial support: The SPRINT study was funded by research grants from the Canadian Institutes of Health Research # MCT-38140 [PI: G.G.], National Institutes of Health NIAMS-072 ; R01 AR48529 [PI: M.S.], Orthopaedic Research and Education Foundation [PI: P.T.], Orthopaedic Trauma Association [PI: M. Bhandari]. Smaller site-specific grants were also obtained from Hamilton Health Sciences Research Grant [PI: M. Bhandari] and Zimmer [PI: M. Bhandari]. Dr. Briel was supported by the Swiss National Foundation [PASMA-112951/1] and the Roche Research Foundation. Dr. Bhandari is funded, in part, by a Canada Research Chair in Musculoskeletal Trauma, McMaster University. The SPRINT Economic Analysis was funded by a grant from the Orthopaedic Research and Education Foundation [PI: W. Creevy]. Trial Registration: Clinicaltrial.gov identifier: NCT00038129 http://www.clinicaltrials.gov . ",

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doi = "10.1016/j.jval.2010.10.034",

language = "English (US)",

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T1 - Economic evaluation of reamed versus unreamed intramedullary nailing in patients with closed and open tibial fractures

T2 - Results from the study to prospectively evaluate reamed intramedullary nails in patients with tibial fractures (SPRINT)

AU - Briel, Matthias

AU - Sprague, Sheila

AU - Heels-Ansdell, Diane

AU - Guyatt, Gordon

AU - Bhandari, Mohit

AU - Blackhouse, Gordon

AU - Sanders, David

AU - Schemitsch, Emil

AU - Swiontkowski, Marc

AU - Tornetta, Paul

AU - Walter, Stephen D.

AU - Goeree, Ron

N1 - Funding Information: Source of financial support: The SPRINT study was funded by research grants from the Canadian Institutes of Health Research # MCT-38140 [PI: G.G.], National Institutes of Health NIAMS-072 ; R01 AR48529 [PI: M.S.], Orthopaedic Research and Education Foundation [PI: P.T.], Orthopaedic Trauma Association [PI: M. Bhandari]. Smaller site-specific grants were also obtained from Hamilton Health Sciences Research Grant [PI: M. Bhandari] and Zimmer [PI: M. Bhandari]. Dr. Briel was supported by the Swiss National Foundation [PASMA-112951/1] and the Roche Research Foundation. Dr. Bhandari is funded, in part, by a Canada Research Chair in Musculoskeletal Trauma, McMaster University. The SPRINT Economic Analysis was funded by a grant from the Orthopaedic Research and Education Foundation [PI: W. Creevy]. Trial Registration: Clinicaltrial.gov identifier: NCT00038129 http://www.clinicaltrials.gov .

PY - 2011/6

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N2 - Introduction: Recently, results from the large, randomized study to prospectively evaluate reamed intramedullary nails in patients with tibial fractures (SPRINT) trial suggested a benefit for reamed intramedullary nail insertion in patients with closed tibial shaft fractures largely based on cost-neutral autodynamizations and a potential advantage for unreamed intramedullary nailing in open fractures. We performed an economic evaluation to compare resource use and effectiveness of reamed and unreamed intramedullary nailing using a cost-utility analysis. Methods: We calculated quality-adjusted life years (QALYs) for each patient from a self-administered health utility index 3 questionnaire for the first 12 months following the intramedullary nailing. A convenience sample of 235 SPRINT patients provided data on costs associated with health care resource utilization. All costs are reported in Canadian dollars for the 2008 financial year. Results: We found incremental effects of -0.017 (95% confidence interval [CI] -0.021-0.058) and -0.002 (95% CI -0.060-0.062) QALYs for patients treated with reamed compared with unreamed intramedullary nails in closed and open fractures, respectively. The incremental costs for reamed compared with unreamed intramedullary nailing were $51 Canadian dollars (95% CI -$2298-$2400) in closed tibial fractures and $2546 Canadian dollars (95%CI -$1773-$6864) in open tibial fractures. Unreamed nailing dominated reamed nailing for both closed and open tibial fractures; however, the cost and the utility results had high variability. Conclusion: Our economic analysis from a governmental perspective suggests small differences in both cost and effectiveness with large uncertainty between reamed and unreamed intramedullary nailing.

AB - Introduction: Recently, results from the large, randomized study to prospectively evaluate reamed intramedullary nails in patients with tibial fractures (SPRINT) trial suggested a benefit for reamed intramedullary nail insertion in patients with closed tibial shaft fractures largely based on cost-neutral autodynamizations and a potential advantage for unreamed intramedullary nailing in open fractures. We performed an economic evaluation to compare resource use and effectiveness of reamed and unreamed intramedullary nailing using a cost-utility analysis. Methods: We calculated quality-adjusted life years (QALYs) for each patient from a self-administered health utility index 3 questionnaire for the first 12 months following the intramedullary nailing. A convenience sample of 235 SPRINT patients provided data on costs associated with health care resource utilization. All costs are reported in Canadian dollars for the 2008 financial year. Results: We found incremental effects of -0.017 (95% confidence interval [CI] -0.021-0.058) and -0.002 (95% CI -0.060-0.062) QALYs for patients treated with reamed compared with unreamed intramedullary nails in closed and open fractures, respectively. The incremental costs for reamed compared with unreamed intramedullary nailing were $51 Canadian dollars (95% CI -$2298-$2400) in closed tibial fractures and $2546 Canadian dollars (95%CI -$1773-$6864) in open tibial fractures. Unreamed nailing dominated reamed nailing for both closed and open tibial fractures; however, the cost and the utility results had high variability. Conclusion: Our economic analysis from a governmental perspective suggests small differences in both cost and effectiveness with large uncertainty between reamed and unreamed intramedullary nailing.

KW - Cost-utility analysis

KW - Economic analysis

KW - Reamed intramedullary nails

KW - Tibia fractures

KW - Unreamed intramedullary nails

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Economic evaluation of reamed versus unreamed intramedullary nailing in patients with closed and open tibial fractures: Results from the study to prospectively evaluate reamed intramedullary nails in patients with tibial fractures (SPRINT)

Abstract

Bibliographical note

Keywords

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