Choosing a strategy for the diagnostic management of suspected scaphoid fracture: a cost-effectiveness analysis.

Abstract

To assess the cost-effectiveness of various strategies for the diagnostic management of clinically suspected scaphoid fracture, a decision-analytic model was built to evaluate three strategies and to compare them with a (clairvoyant) reference diagnostic management strategy. Evaluated strategies were: (A) repeated radiography up to 2 wk; (B) repeat radiography up to 6 wk; and (C) radiography, followed by bone scintigraphy in patients with negative initial radiographs. Therapy consisted of 12 wk of immobilization for a radiographically or scintigraphically proven fracture. Diagnostic costs, therapeutic costs, period of immobilization and nonunion rate were calculated for all three strategies. Estimates were derived from a descriptive management study using bone scintigraphy and available literature. Sensitivity analyses were performed. Overall costs were 273.7, 317.7 and 316.1 European Currency Units (ECU) for Strategies A, B and C, respectively (1 ECU = 1.15 U.S. dollar). Strategy B led to the longest average period of immobilization (8.6 wk), while Strategy A resulted in the highest nonunion rate (4.7%). The costs per nonunion saved for the additional use of bone scintigraphy (Strategy C) was ECU 2618 when compared to Strategy A. The use of bone scintigraphy in the diagnostic management of scaphoid fractures is accurate, convenient for patients and cost-effective.