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.
Bibliographical noteFunding 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 .
- Cost-utility analysis
- Economic analysis
- Reamed intramedullary nails
- Tibia fractures
- Unreamed intramedullary nails