Cost-effectiveness of introducing cone-beam computed tomography (CBCT) in the management of complex phalangeal fractures
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ORIGINAL ARTICLE
Cost‑effectiveness of introducing cone‑beam computed tomography (CBCT) in the management of complex phalangeal fractures: economic simulation N. Faccioli1 · E. Santi1 · G. Foti2 · G. Mansueto1 · M. Corain3 Received: 12 February 2020 / Accepted: 2 November 2020 © The Author(s) 2020
Abstract Purpose The purpose of this study was to evaluate the cost-effectiveness of introducing cone-beam computed tomography (CBCT) in the management of the complex finger fractures with articular involvement. Methods We created a decision tree model simulating the diagnostic pathway of complex finger fractures, suggesting the use of CBCT as alternative to multi-slice computed tomography (MSCT), and we compared their clinical outcomes, costs, and cost-effectiveness for a hypothetical cohort of 10,000 patients. Measures of effectiveness are analysed by using qualityadjusted life years, incremental cost-effectiveness ratio, and net monetary benefit. Results Diagnosis of a complex finger fracture performed with CBCT costed 67.33€ per patient, yielded 9.08 quality-adjusted life years, and gained an incremental cost-effectiveness ratio of 29.94€ and a net monetary benefit of 9.07 € at 30,000€ threshold. Using MSCT for diagnosis costed 106.23 €, yielded 8.18 quality-adjusted life years, and gained an incremental cost-effectiveness ratio of 371.15 € and a net monetary benefit of 8.09 €. CBCT strategy dominated the MSCT strategy. The acceptability curve shows that there is 98% probability of CBCT being the optimal strategy at 30,000€ threshold (1 EUR equal to 1.11 USD; updated on 02/02/2020). Conclusion CBCT in complex finger fractures management is cost saving compared with MSCT and may be considered a valuable imaging tool in preoperative assessment, allowing early detection and appropriate treatment. It shortens the time to completion of diagnostic work-up, reduces the number of additional diagnostic procedures, improves quality of life, and may reduce costs in a societal perspective. Keyword Cost-effectiveness · Cone-beam computed tomography · Complex phalangeal fractures · Finger · Multi-slice computed tomography Abbreviations CT Computed tomography CBCT Cone-beam computed tomography MSCT Multi-slice computed tomography QALY Quality-adjusted life year ICER Incremental cost-effectiveness ratio
NMB Net monetary benefit iNMB Incremental net monetary benefit QoL Quality of life
* N. Faccioli [email protected]
1
E. Santi [email protected]
Department of Radiology, G.B. Rossi University Hospital, University of Verona, Piazzale L.A.Scuro 10, 37134 Verona, Italy
2
G. Foti [email protected]
IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
3
Hand Surgery Department, G.B. Rossi University Hospital, Piazzale L.A.Scuro 10, 37134 Verona, Italy
G. Mansueto [email protected] M. Corain [email protected]
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Introduction Finger fractures are frequent injuries, comprising 10–25% of all fracture-related visits in Emergency Department [1, 2].
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