Cost-effectiveness of cast treatment vs. surgery in elderly patients with substantially displaced intra-articular distal radius fractures: A trial-based economic evaluation

Dirk P. ter Meulen; Johanna M. van Dongen; Ydo V. Kleinlugtenbelt; On behalf of the DART study group; Gerald A. Kraan; J. Carel Goslings; Niels W.L. Schep; Nienke W. Willigenburg; Rudolf W. Poolman; W. H. Mallee; D. H.R. Kempen; D. F.P. van Deurzen; A. Rasker; V. A. van de Graaf; H. R. van den Berg; R. N. van Veen; R. Haverlag; M. P. Simons; P. W.J. van Rutte; H. A. Formijne Jonkers; N. M.C. Mathijssen; M. R. de Vries; J. Vermeulen; P. A. Jawahier; B. I. Cleffken; R. G. Zuurmond; S. H. van Helden; M. C.Q. Steinweg; A. H. van der Veen; E. R. Flikweert; E. B.M. Landman; N. Sosef; I. N. Sierevelt; B. A. van Dijkman; A. J. Dijkstra; J. Olde Heuvel; S. Romijn; B. C. van der Zwaard; K. W.W. Lansink; T. Gosens; J. P.M. Frölke; E. J.M.M. Verleisdonk; R. J.P. van der Wal; D. Haverkamp; G. M.M.J. Kerkhoffs; B. A. Twigt; M. Rutgers; M. A.M. Mulders; C. A. Selles; J. W. Colaris; H. C. Willems

doi:10.1371/journal.pone.0339489

Cost-effectiveness of cast treatment vs. surgery in elderly patients with substantially displaced intra-articular distal radius fractures: A trial-based economic evaluation

Dirk P. ter Meulen^*
, Johanna M. van Dongen
, Ydo V. Kleinlugtenbelt
, On behalf of the DART study group
, Gerald A. Kraan
, J. Carel Goslings
, Niels W.L. Schep
, Nienke W. Willigenburg
, Rudolf W. Poolman
, W. H. Mallee
, D. H.R. Kempen
, D. F.P. van Deurzen
, A. Rasker
, V. A. van de Graaf
, H. R. van den Berg
, R. N. van Veen
, R. Haverlag
, M. P. Simons
, P. W.J. van Rutte
, H. A. Formijne Jonkers

N. M.C. Mathijssen, M. R. de Vries, J. Vermeulen, P. A. Jawahier, B. I. Cleffken, R. G. Zuurmond, S. H. van Helden, M. C.Q. Steinweg, A. H. van der Veen, E. R. Flikweert, E. B.M. Landman, N. Sosef, I. N. Sierevelt, B. A. van Dijkman, A. J. Dijkstra, J. Olde Heuvel, S. Romijn, B. C. van der Zwaard, K. W.W. Lansink, T. Gosens, J. P.M. Frölke, E. J.M.M. Verleisdonk, R. J.P. van der Wal, D. Haverkamp, G. M.M.J. Kerkhoffs, B. A. Twigt, M. Rutgers, M. A.M. Mulders, C. A. Selles, J. W. Colaris, H. C. Willems

^*Corresponding author for this work

Orthopedics and Sports Medicine

Onze Lieve Vrouwe Gasthuis
Vrije Universiteit Amsterdam
Deventer Ziekenhuis
Reinier de Graaf Groep
Leiden University
Maasstad Hospital
Isala Clinics
Spaarne Gasthuis
Flevo Hospital
OCON Orthopedic Clinic Hengelo
Jeroen Bosch Ziekenhuis
ETZ Elisabeth
Radboud University Medical Center
Diakonessenhuis Utrecht
orthopedic surgery department
BovenIJ Hospital

Research output: Contribution to journal › Article › Academic › peer-review

2 Downloads (Pure)

Abstract

Background The number of surgical procedures for distal radius fractures in the elderly has increased, even though most studies show little or no benefit over cast treatment. While medical costs of surgical treatment are higher than those of cast treatment, surgery may enable faster recovery and help patients maintain independence, potentially reducing their use of other healthcare resources and informal care. Methods We evaluated whether cast treatment is cost-effective compared to surgery for patients aged 65 years or older with substantially displaced intra-articular distal radius fractures. A multicentre randomized controlled non-inferiority trial with an economic evaluation in 19 hospitals in the Netherlands. Participants completed (cost) questionnaires at baseline, 3, 6, 9 and 12 months after trauma. A total of 138 patients were randomized between cast treatment and surgery. Health-related quality of life was measured with the EQ-5D-3L; wrist function was measured with the Patient Rated Wrist Evaluation (PRWE). Costs were assessed from a societal perspective, including intervention costs, healthcare use, informal care, unpaid productivity losses, and patients’ own expenses. Results The estimated difference in total societal costs was -€81 (95%CI -€3936 to €3773) in favour of cast treatment compared with surgical treatment. Compared with cast treatment, surgery resulted in improved wrist function (PRWE: −5.5; 95% CI: −10 to −0.7) and slightly higher QALYs (+0.039; 95%CI 0.012 to 0.066), equivalent to 14 days in perfect health. The incremental cost-effectiveness ratio was €15 per point improvement in PRWE and €2070 per QALY gained. Cast treatment’s probability of cost-effectiveness was low for all values of willingness to pay. Conclusion Although cast treatment had lower direct costs, these were offset by higher informal and secondary care costs. Surgical treatment offered clinically relevant short-term benefits. From a societal perspective, surgery appears to be the more favorable option for elderly patients with displaced distal radius fractures.

Original language	English
Article number	e0339489
Journal	PLoS ONE
Volume	21
Issue number	1 January
DOIs	https://doi.org/10.1371/journal.pone.0339489
Publication status	Published - 30 Jan 2026

Bibliographical note

Access to Document

10.1371/journal.pone.0339489Licence: CC BY

journal.pone.0339489Final published version, 554 KBLicence: CC BY

Cite this

ter Meulen, D. P., van Dongen, J. M., Kleinlugtenbelt, Y. V., On behalf of the DART study group, Kraan, G. A., Goslings, J. C., Schep, N. W. L., Willigenburg, N. W., Poolman, R. W., Mallee, W. H., Kempen, D. H. R., van Deurzen, D. F. P., Rasker, A., van de Graaf, V. A., van den Berg, H. R., van Veen, R. N., Haverlag, R., Simons, M. P., van Rutte, P. W. J., ... Willems, H. C. (2026). Cost-effectiveness of cast treatment vs. surgery in elderly patients with substantially displaced intra-articular distal radius fractures: A trial-based economic evaluation. PLoS ONE, 21(1 January), Article e0339489. https://doi.org/10.1371/journal.pone.0339489

@article{5fa4a83efc5a4344946e07b73139d59f,

title = "Cost-effectiveness of cast treatment vs. surgery in elderly patients with substantially displaced intra-articular distal radius fractures: A trial-based economic evaluation",

abstract = "Background The number of surgical procedures for distal radius fractures in the elderly has increased, even though most studies show little or no benefit over cast treatment. While medical costs of surgical treatment are higher than those of cast treatment, surgery may enable faster recovery and help patients maintain independence, potentially reducing their use of other healthcare resources and informal care. Methods We evaluated whether cast treatment is cost-effective compared to surgery for patients aged 65 years or older with substantially displaced intra-articular distal radius fractures. A multicentre randomized controlled non-inferiority trial with an economic evaluation in 19 hospitals in the Netherlands. Participants completed (cost) questionnaires at baseline, 3, 6, 9 and 12 months after trauma. A total of 138 patients were randomized between cast treatment and surgery. Health-related quality of life was measured with the EQ-5D-3L; wrist function was measured with the Patient Rated Wrist Evaluation (PRWE). Costs were assessed from a societal perspective, including intervention costs, healthcare use, informal care, unpaid productivity losses, and patients{\textquoteright} own expenses. Results The estimated difference in total societal costs was -€81 (95\%CI -€3936 to €3773) in favour of cast treatment compared with surgical treatment. Compared with cast treatment, surgery resulted in improved wrist function (PRWE: −5.5; 95\% CI: −10 to −0.7) and slightly higher QALYs (+0.039; 95\%CI 0.012 to 0.066), equivalent to 14 days in perfect health. The incremental cost-effectiveness ratio was €15 per point improvement in PRWE and €2070 per QALY gained. Cast treatment{\textquoteright}s probability of cost-effectiveness was low for all values of willingness to pay. Conclusion Although cast treatment had lower direct costs, these were offset by higher informal and secondary care costs. Surgical treatment offered clinically relevant short-term benefits. From a societal perspective, surgery appears to be the more favorable option for elderly patients with displaced distal radius fractures.",

author = "\{ter Meulen\}, \{Dirk P.\} and \{van Dongen\}, \{Johanna M.\} and Kleinlugtenbelt, \{Ydo V.\} and \{On behalf of the DART study group\} and Kraan, \{Gerald A.\} and Goslings, \{J. Carel\} and Schep, \{Niels W.L.\} and Willigenburg, \{Nienke W.\} and Poolman, \{Rudolf W.\} and Mallee, \{W. H.\} and Kempen, \{D. H.R.\} and \{van Deurzen\}, \{D. F.P.\} and A. Rasker and \{van de Graaf\}, \{V. A.\} and \{van den Berg\}, \{H. R.\} and \{van Veen\}, \{R. N.\} and R. Haverlag and Simons, \{M. P.\} and \{van Rutte\}, \{P. W.J.\} and \{Formijne Jonkers\}, \{H. A.\} and Mathijssen, \{N. M.C.\} and \{de Vries\}, \{M. R.\} and J. Vermeulen and Jawahier, \{P. A.\} and Cleffken, \{B. I.\} and Zuurmond, \{R. G.\} and \{van Helden\}, \{S. H.\} and Steinweg, \{M. C.Q.\} and \{van der Veen\}, \{A. H.\} and Flikweert, \{E. R.\} and Landman, \{E. B.M.\} and N. Sosef and Sierevelt, \{I. N.\} and \{van Dijkman\}, \{B. A.\} and Dijkstra, \{A. J.\} and Heuvel, \{J. Olde\} and S. Romijn and \{van der Zwaard\}, \{B. C.\} and Lansink, \{K. W.W.\} and T. Gosens and Fr{\"o}lke, \{J. P.M.\} and Verleisdonk, \{E. J.M.M.\} and \{van der Wal\}, \{R. J.P.\} and D. Haverkamp and Kerkhoffs, \{G. M.M.J.\} and Twigt, \{B. A.\} and M. Rutgers and Mulders, \{M. A.M.\} and Selles, \{C. A.\} and Colaris, \{J. W.\} and Willems, \{H. C.\}",

note = "Publisher Copyright: {\textcopyright} 2026 ter Meulen et al. ",

year = "2026",

month = jan,

day = "30",

doi = "10.1371/journal.pone.0339489",

language = "English",

volume = "21",

journal = "PLoS ONE",

issn = "1932-6203",

publisher = "Public Library of Science",

number = "1 January",

}

ter Meulen, DP, van Dongen, JM, Kleinlugtenbelt, YV, On behalf of the DART study group, Kraan, GA, Goslings, JC, Schep, NWL, Willigenburg, NW, Poolman, RW, Mallee, WH, Kempen, DHR, van Deurzen, DFP, Rasker, A, van de Graaf, VA, van den Berg, HR, van Veen, RN, Haverlag, R, Simons, MP, van Rutte, PWJ, Formijne Jonkers, HA, Mathijssen, NMC, de Vries, MR, Vermeulen, J, Jawahier, PA, Cleffken, BI, Zuurmond, RG, van Helden, SH, Steinweg, MCQ, van der Veen, AH, Flikweert, ER, Landman, EBM, Sosef, N, Sierevelt, IN, van Dijkman, BA, Dijkstra, AJ, Heuvel, JO, Romijn, S, van der Zwaard, BC, Lansink, KWW, Gosens, T, Frölke, JPM, Verleisdonk, EJMM, van der Wal, RJP, Haverkamp, D, Kerkhoffs, GMMJ, Twigt, BA, Rutgers, M, Mulders, MAM, Selles, CA, Colaris, JW & Willems, HC 2026, 'Cost-effectiveness of cast treatment vs. surgery in elderly patients with substantially displaced intra-articular distal radius fractures: A trial-based economic evaluation', PLoS ONE, vol. 21, no. 1 January, e0339489. https://doi.org/10.1371/journal.pone.0339489

Cost-effectiveness of cast treatment vs. surgery in elderly patients with substantially displaced intra-articular distal radius fractures: A trial-based economic evaluation. / ter Meulen, Dirk P.; van Dongen, Johanna M.; Kleinlugtenbelt, Ydo V. et al.
In: PLoS ONE, Vol. 21, No. 1 January, e0339489, 30.01.2026.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Cost-effectiveness of cast treatment vs. surgery in elderly patients with substantially displaced intra-articular distal radius fractures

T2 - A trial-based economic evaluation

AU - ter Meulen, Dirk P.

AU - van Dongen, Johanna M.

AU - Kleinlugtenbelt, Ydo V.

AU - On behalf of the DART study group

AU - Kraan, Gerald A.

AU - Goslings, J. Carel

AU - Schep, Niels W.L.

AU - Willigenburg, Nienke W.

AU - Poolman, Rudolf W.

AU - Mallee, W. H.

AU - Kempen, D. H.R.

AU - van Deurzen, D. F.P.

AU - Rasker, A.

AU - van de Graaf, V. A.

AU - van den Berg, H. R.

AU - van Veen, R. N.

AU - Haverlag, R.

AU - Simons, M. P.

AU - van Rutte, P. W.J.

AU - Formijne Jonkers, H. A.

AU - Mathijssen, N. M.C.

AU - de Vries, M. R.

AU - Vermeulen, J.

AU - Jawahier, P. A.

AU - Cleffken, B. I.

AU - Zuurmond, R. G.

AU - van Helden, S. H.

AU - Steinweg, M. C.Q.

AU - van der Veen, A. H.

AU - Flikweert, E. R.

AU - Landman, E. B.M.

AU - Sosef, N.

AU - Sierevelt, I. N.

AU - van Dijkman, B. A.

AU - Dijkstra, A. J.

AU - Heuvel, J. Olde

AU - Romijn, S.

AU - van der Zwaard, B. C.

AU - Lansink, K. W.W.

AU - Gosens, T.

AU - Frölke, J. P.M.

AU - Verleisdonk, E. J.M.M.

AU - van der Wal, R. J.P.

AU - Haverkamp, D.

AU - Kerkhoffs, G. M.M.J.

AU - Twigt, B. A.

AU - Rutgers, M.

AU - Mulders, M. A.M.

AU - Selles, C. A.

AU - Colaris, J. W.

AU - Willems, H. C.

PY - 2026/1/30

Y1 - 2026/1/30

N2 - Background The number of surgical procedures for distal radius fractures in the elderly has increased, even though most studies show little or no benefit over cast treatment. While medical costs of surgical treatment are higher than those of cast treatment, surgery may enable faster recovery and help patients maintain independence, potentially reducing their use of other healthcare resources and informal care. Methods We evaluated whether cast treatment is cost-effective compared to surgery for patients aged 65 years or older with substantially displaced intra-articular distal radius fractures. A multicentre randomized controlled non-inferiority trial with an economic evaluation in 19 hospitals in the Netherlands. Participants completed (cost) questionnaires at baseline, 3, 6, 9 and 12 months after trauma. A total of 138 patients were randomized between cast treatment and surgery. Health-related quality of life was measured with the EQ-5D-3L; wrist function was measured with the Patient Rated Wrist Evaluation (PRWE). Costs were assessed from a societal perspective, including intervention costs, healthcare use, informal care, unpaid productivity losses, and patients’ own expenses. Results The estimated difference in total societal costs was -€81 (95%CI -€3936 to €3773) in favour of cast treatment compared with surgical treatment. Compared with cast treatment, surgery resulted in improved wrist function (PRWE: −5.5; 95% CI: −10 to −0.7) and slightly higher QALYs (+0.039; 95%CI 0.012 to 0.066), equivalent to 14 days in perfect health. The incremental cost-effectiveness ratio was €15 per point improvement in PRWE and €2070 per QALY gained. Cast treatment’s probability of cost-effectiveness was low for all values of willingness to pay. Conclusion Although cast treatment had lower direct costs, these were offset by higher informal and secondary care costs. Surgical treatment offered clinically relevant short-term benefits. From a societal perspective, surgery appears to be the more favorable option for elderly patients with displaced distal radius fractures.

AB - Background The number of surgical procedures for distal radius fractures in the elderly has increased, even though most studies show little or no benefit over cast treatment. While medical costs of surgical treatment are higher than those of cast treatment, surgery may enable faster recovery and help patients maintain independence, potentially reducing their use of other healthcare resources and informal care. Methods We evaluated whether cast treatment is cost-effective compared to surgery for patients aged 65 years or older with substantially displaced intra-articular distal radius fractures. A multicentre randomized controlled non-inferiority trial with an economic evaluation in 19 hospitals in the Netherlands. Participants completed (cost) questionnaires at baseline, 3, 6, 9 and 12 months after trauma. A total of 138 patients were randomized between cast treatment and surgery. Health-related quality of life was measured with the EQ-5D-3L; wrist function was measured with the Patient Rated Wrist Evaluation (PRWE). Costs were assessed from a societal perspective, including intervention costs, healthcare use, informal care, unpaid productivity losses, and patients’ own expenses. Results The estimated difference in total societal costs was -€81 (95%CI -€3936 to €3773) in favour of cast treatment compared with surgical treatment. Compared with cast treatment, surgery resulted in improved wrist function (PRWE: −5.5; 95% CI: −10 to −0.7) and slightly higher QALYs (+0.039; 95%CI 0.012 to 0.066), equivalent to 14 days in perfect health. The incremental cost-effectiveness ratio was €15 per point improvement in PRWE and €2070 per QALY gained. Cast treatment’s probability of cost-effectiveness was low for all values of willingness to pay. Conclusion Although cast treatment had lower direct costs, these were offset by higher informal and secondary care costs. Surgical treatment offered clinically relevant short-term benefits. From a societal perspective, surgery appears to be the more favorable option for elderly patients with displaced distal radius fractures.

UR - https://www.scopus.com/pages/publications/105028911293

U2 - 10.1371/journal.pone.0339489

DO - 10.1371/journal.pone.0339489

M3 - Article

C2 - 41616035

AN - SCOPUS:105028911293

SN - 1932-6203

VL - 21

JO - PLoS ONE

JF - PLoS ONE

IS - 1 January

M1 - e0339489

ER -

Cost-effectiveness of cast treatment vs. surgery in elderly patients with substantially displaced intra-articular distal radius fractures: A trial-based economic evaluation

Abstract

Bibliographical note

Access to Document

Other files and links

Fingerprint

Cite this