The cost-utility analysis for the treatment of pediatric femoral shaft fracture

Abstract

Background: Hip spica cast, plate and screw fixation, elastic nail fixation and external fixation are used to manage femoral fractures in children. Currently, there is still lacking evidence of the full economic evaluation for various treatments of pediatric femoral shaft fractures. This study was aimed to determine the cost-utility for the pediatric femoral shaft fracture treatment methods. Methods: A bidirectional cohort study included children aged 2–11 years old with femoral shaft fracture at the university hospital between January 2001 and December 2021. Direct medical and non-medical costs were retrieved from medical records and telephone interview, while quality adjusted life year (QALY) was derived from EQ-5D-5L questionnaire. Considering both hospital and societal perspective, cost-utility analysis was assessed by incremental cost-effective ratio (ICER). The one-way sensitivity analysis was done according to varying parameters, and a Tornado diagram was generated. Results: Twelve patients were included with mean age 7.6 ± 3.1 years, and 7 females (58.3%). Treatment distributions were 3 (25%) hip spica (HS), 8 (66.7%) plate and screws (PS), and one (8.3%) external fixation (EF). Regarding HS vs. PS, QALY was 0.981 vs. 0.958 (P = 0.393), and the leg length discrepancy was 8.3 mm vs. 8.0 mm (P = 0.903). Direct medical cost was 28,465 vs. 37,277 Baht (P = 0.047), and direct non-medical cost was 100,000 vs. 97,250 Baht (P = 0.570). When compared to PS, HS had lower ICER for hospital perspective − 383,152 Baht/QALY and for societal perspective − 263,587 Baht/QALY. Admission, and PS operation cost mostly contributed to cost-utility pattern. Conclusion: HS provides cost-utility advantages for the treatment of pediatric femoral shaft fractures when compared to PS. Small samples for each treatment, especially EF, comes up with insufficient power to detect significant difference between groups. Further comprehensive study including other operations with adequate sample size is required.