Skip to main content
Journal cover image

Cost-effectiveness analysis of total elbow arthroplasty versus open reduction-internal fixation for distal humeral fractures.

Publication ,  Journal Article
Federer, AE; Mather, RC; Ramsey, ML; Garrigues, GE
Published in: J Shoulder Elbow Surg
January 2019

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.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

J Shoulder Elbow Surg

DOI

EISSN

1532-6500

Publication Date

January 2019

Volume

28

Issue

1

Start / End Page

102 / 111

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Retrospective Studies
  • Quality-Adjusted Life Years
  • Quality of Life
  • Orthopedics
  • Open Fracture Reduction
  • Middle Aged
  • Male
  • Humeral Fractures
  • Humans
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Federer, A. E., Mather, R. C., Ramsey, M. L., & Garrigues, G. E. (2019). Cost-effectiveness analysis of total elbow arthroplasty versus open reduction-internal fixation for distal humeral fractures. J Shoulder Elbow Surg, 28(1), 102–111. https://doi.org/10.1016/j.jse.2018.08.041
Federer, Andrew E., Richard C. Mather, Matthew L. Ramsey, and Grant E. Garrigues. “Cost-effectiveness analysis of total elbow arthroplasty versus open reduction-internal fixation for distal humeral fractures.J Shoulder Elbow Surg 28, no. 1 (January 2019): 102–11. https://doi.org/10.1016/j.jse.2018.08.041.
Federer AE, Mather RC, Ramsey ML, Garrigues GE. Cost-effectiveness analysis of total elbow arthroplasty versus open reduction-internal fixation for distal humeral fractures. J Shoulder Elbow Surg. 2019 Jan;28(1):102–11.
Federer, Andrew E., et al. “Cost-effectiveness analysis of total elbow arthroplasty versus open reduction-internal fixation for distal humeral fractures.J Shoulder Elbow Surg, vol. 28, no. 1, Jan. 2019, pp. 102–11. Pubmed, doi:10.1016/j.jse.2018.08.041.
Federer AE, Mather RC, Ramsey ML, Garrigues GE. Cost-effectiveness analysis of total elbow arthroplasty versus open reduction-internal fixation for distal humeral fractures. J Shoulder Elbow Surg. 2019 Jan;28(1):102–111.
Journal cover image

Published In

J Shoulder Elbow Surg

DOI

EISSN

1532-6500

Publication Date

January 2019

Volume

28

Issue

1

Start / End Page

102 / 111

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Retrospective Studies
  • Quality-Adjusted Life Years
  • Quality of Life
  • Orthopedics
  • Open Fracture Reduction
  • Middle Aged
  • Male
  • Humeral Fractures
  • Humans