The authors declare that they have no competing interests.
PFWH was applicant for the research grant and responsible for design of the study, patient recruitment in Maastricht University Medical Centre, acquisition, analysis and interpretation of all data, drafting and revision of the manuscript and is corresponding author. BABE performed the statistical and cost-utility analyses and was responsible for interpretation of all data and revision of the manuscript. JPMS was responsible for analysis and interpretation of all data and drafting and revision of the manuscript. KD performed the acquisition, registration, analysis and interpretation of all data. MP recruited patients in Maastricht University Medical Centre, participated in the design of the study and performed statistical analysis of all data as well as revision of the manuscript. PRGB recruited patients in Maastricht University Medical Centre, coordinated the research project and participated in design of the study and revision of the manuscript. All authors read and approved the final manuscript.
Physical forces have been widely used to stimulate bone growth in fracture repair. Addition of bone growth stimulation to the conservative treatment regime is more costly than standard health care. However, it might lead to cost-savings due to a reduction of the total amount of working days lost. This economic evaluation was performed to assess the cost-effectiveness of Pulsed Electromagnetic Fields (PEMF) compared to standard health care in the treatment of acute scaphoid fractures.
An economic evaluation was carried out from a societal perspective, alongside a double-blind, randomized, placebo-controlled, multicenter trial involving five centres in the Netherlands. One hundred and two patients with a clinically and radiographically proven fracture of the scaphoid were included in the study and randomly allocated to either active bone growth stimulation or standard health care, using a placebo. All costs (medical costs and costs due to productivity loss) were measured during one year follow up. Functional outcome and general health related quality of life were assessed by the EuroQol-5D and PRWHE (patient rated wrist and hand evaluation) questionnaires. Utility scores were derived from the EuroQol-5D.
The average total number of working days lost was lower in the active PEMF group (9.82 days) compared to the placebo group (12.91 days) (p = 0.651). Total medical costs of the intervention group (€1594) were significantly higher compared to the standard health care (€875). The total amount of mean QALY’s (quality-adjusted life year) for the active PEMF group was 0.84 and 0.85 for the control group. The cost-effectiveness plane shows that the majority of all cost-effectiveness ratios fall into the quadrant where PEMF is not only less effective in terms of QALY’s but also more costly.
This study demonstrates that the desired effects in terms of cost-effectiveness are not met. When comparing the effects of PEMF to standard health care in terms of QALY’s, PEMF cannot be considered a cost-effective treatment for acute fractures of the scaphoid bone.
Netherlands Trial Register (NTR): NTR2064
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- Functional outcome and cost-effectiveness of pulsed electromagnetic fields in the treatment of acute scaphoid fractures: a cost-utility analysis
Pascal F W Hannemann
Brigitte A B Essers
Judith P M Schots
Peter R G Brink
- BioMed Central
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