Functional outcome and cost-effectiveness of pulsed electromagnetic fields in the treatment of acute scaphoid fractures: a cost-utility analysis

P.F.W. Hannemann, B.A.B. Essers, J.P.M. Schots, K. Dullaert, M. Poeze, P.R.G. Brink

Research output: Contribution to journalArticleAcademicpeer-review

2 Citations (Scopus)

Abstract

Background: 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.

Methods: 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.

Results: 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 ([SIC]1594) were significantly higher compared to the standard health care ([SIC]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.

Conclusion: 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.

Original languageEnglish
Article number84
Number of pages10
JournalBMC Musculoskeletal Disorders
Volume16
DOIs
Publication statusPublished - 11 Apr 2015

Keywords

  • Scaphoid
  • Pulsed electromagnetic fields
  • Acute fractures
  • Cost-effectiveness analysis
  • Cost-utility analysis
  • Functional outcome
  • DOUBLE-BLIND
  • COMPUTED-TOMOGRAPHY
  • RANDOMIZED-TRIAL
  • MULTICENTER
  • ULTRASOUND
  • STIMULATION
  • FIXATION
  • UNION
  • SCREW

Cite this

@article{a8e156ab0f354a7abb1457bc401bf4ef,
title = "Functional outcome and cost-effectiveness of pulsed electromagnetic fields in the treatment of acute scaphoid fractures: a cost-utility analysis",
abstract = "Background: 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.Methods: 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.Results: 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 ([SIC]1594) were significantly higher compared to the standard health care ([SIC]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.Conclusion: 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.",
keywords = "Scaphoid, Pulsed electromagnetic fields, Acute fractures, Cost-effectiveness analysis, Cost-utility analysis, Functional outcome, DOUBLE-BLIND, COMPUTED-TOMOGRAPHY, RANDOMIZED-TRIAL, MULTICENTER, ULTRASOUND, STIMULATION, FIXATION, UNION, SCREW",
author = "P.F.W. Hannemann and B.A.B. Essers and J.P.M. Schots and K. Dullaert and M. Poeze and P.R.G. Brink",
year = "2015",
month = "4",
day = "11",
doi = "10.1186/s12891-015-0541-2",
language = "English",
volume = "16",
journal = "BMC Musculoskeletal Disorders",
issn = "1471-2474",
publisher = "BioMed Central Ltd",

}

Functional outcome and cost-effectiveness of pulsed electromagnetic fields in the treatment of acute scaphoid fractures: a cost-utility analysis. / Hannemann, P.F.W.; Essers, B.A.B.; Schots, J.P.M.; Dullaert, K.; Poeze, M.; Brink, P.R.G.

In: BMC Musculoskeletal Disorders, Vol. 16, 84, 11.04.2015.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Functional outcome and cost-effectiveness of pulsed electromagnetic fields in the treatment of acute scaphoid fractures: a cost-utility analysis

AU - Hannemann, P.F.W.

AU - Essers, B.A.B.

AU - Schots, J.P.M.

AU - Dullaert, K.

AU - Poeze, M.

AU - Brink, P.R.G.

PY - 2015/4/11

Y1 - 2015/4/11

N2 - Background: 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.Methods: 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.Results: 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 ([SIC]1594) were significantly higher compared to the standard health care ([SIC]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.Conclusion: 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.

AB - Background: 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.Methods: 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.Results: 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 ([SIC]1594) were significantly higher compared to the standard health care ([SIC]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.Conclusion: 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.

KW - Scaphoid

KW - Pulsed electromagnetic fields

KW - Acute fractures

KW - Cost-effectiveness analysis

KW - Cost-utility analysis

KW - Functional outcome

KW - DOUBLE-BLIND

KW - COMPUTED-TOMOGRAPHY

KW - RANDOMIZED-TRIAL

KW - MULTICENTER

KW - ULTRASOUND

KW - STIMULATION

KW - FIXATION

KW - UNION

KW - SCREW

U2 - 10.1186/s12891-015-0541-2

DO - 10.1186/s12891-015-0541-2

M3 - Article

VL - 16

JO - BMC Musculoskeletal Disorders

JF - BMC Musculoskeletal Disorders

SN - 1471-2474

M1 - 84

ER -