Economic evaluation of operative versus nonoperative treatment of a humeral shaft fracture: economic analyses alongside a multicenter prospective cohort study (HUMMER)

Saskia H. Van Bergen; Esther M.M. Van Lieshout; Kiran C. Mahabier; Alexandra J.L.M. Geraerds; Suzanne Polinder; Dennis Den Hartog; Michael H.J. Verhofstad; the HUMMER Investigators; Marije Notenboom

doi:10.1007/s00068-022-02160-1

Economic evaluation of operative versus nonoperative treatment of a humeral shaft fracture: economic analyses alongside a multicenter prospective cohort study (HUMMER)

Saskia H. Van Bergen, Esther M.M. Van Lieshout, Kiran C. Mahabier, Alexandra J.L.M. Geraerds, Suzanne Polinder, Dennis Den Hartog^*, Michael H.J. Verhofstad, the HUMMER Investigators, Marije Notenboom

^*Corresponding author for this work

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

1 Citation (Scopus)

11 Downloads (Pure)

Abstract

Purpose: Operative treatment of a humeral shaft fracture results in faster recovery than nonoperative treatment. The cost-effectiveness, in terms of costs per Quality-Adjusted Life Year (QALY) gained (Dutch threshold €20,000-€80,000) or minimal important change (MIC) in disability reduced (DASH 6.7), is unknown. The aim of this study was to determine cost-utility and cost-effectiveness of operative versus nonoperative treatment in adults with a humeral shaft fracture type 12A or 12B. Methods: This study was performed alongside a multicenter prospective cohort study. Costs for health care and lost productivity until one year after trauma were calculated. The incremental cost-utility ratio (ICUR) was reported in costs per QALY (based on the EuroQoL-5D-3L (EQ-5D)) gained. The incremental cost-effectiveness ratio (ICER) was reported in costs per MIC (based on the DASH score at three months) reduced. Results: Overall, 245 patients were treated operatively and 145 nonoperatively. In the operative group, the mean total costs per patient (€11,925 versus €8793; p < 0.001) and QALYs (0.806 versus 0.778; p < 0.001) were higher. The ICUR of operative treatment was €111,860 per QALY gained (i.e., €3132/0.028). The DASH was 7.3 points (p < 0.001) lower in the operative group. The ICER of operative treatment was €2880 per MIC in disability reduced (i.e., €3132/7.3*6.7). Conclusion: Due to the limited effect of treatment on quality of life measured with the EQ-5D, the ICUR of operative treatment (€111,860 per QALY gained) exceeds the threshold. However, the incremental costs of €2880 per clinically meaningful difference in DASH are much lower and suggest that operative treatment for a humeral shaft fracture is cost-effective.

Original language	English
Pages (from-to)	929-938
Number of pages	10
Journal	European Journal of Trauma and Emergency Surgery
Volume	49
Issue number	2
Early online date	8 Dec 2022
DOIs	https://doi.org/10.1007/s00068-022-02160-1
Publication status	Published - Apr 2023

Bibliographical note

Funding Information:
HUMMER INVESTIGATORS: Local principal investigators and co-investigators: Ivo Beetz, MD PhD, Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. Hugo W. Bolhuis, MD, Department of Surgery, Gelre Hospital, Apeldoorn, The Netherlands. P. Koen Bos, MD PhD, Department of Orthopaedic Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. Maarten W.G.A. Bronkhorst, MD PhD, Trauma Unit, Haaglanden MC, The Hague, The Netherlands. Milko M.M. Bruijninckx, MD, Department of Surgery, IJsselland Hospital, Capelle a/d Ijssel, The Netherlands. Jeroen De Haan, MD PhD, Department of Surgery, Dijklanderziekenhuis, Hoorn, The Netherlands. Axel R. Deenik, MD PhD, Department of Orthopaedic Surgery, Haaglanden MC, The Hague, The Netherlands. P. Ted Den Hoed, MD PhD, Department of Surgery, Ikazia Hospital, Rotterdam, The Netherlands. Martin G. Eversdijk, MD, Department of Surgery, St. Jansdal Hospital, Harderwijk, The Netherlands. J. Carel Goslings, MD PhD, Trauma Unit Department of Surgery, Amsterdam University, Medical Center, location AMC, Amsterdam, The Netherlands. Robert Haverlag, MD, Department of Surgery, OLVG Hospital, Amsterdam, The Netherlands. Martin J. Heetveld, MD PhD, Department of Surgery, Spaarne Gasthuis, Haarlem, The Netherlands. Albertus J.H. Kerver, MD PhD, Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands. Karel A. Kolkman, MD, Department of Surgery, Rijnstate, Arnhem, The Netherlands. Peter A. Leenhouts, MD, Department of Surgery, Zaans Medical Center, Zaandam, The Netherlands. Sven A.G. Meylaerts, MD PhD, Trauma Unit, Haaglanden MC, The Hague, The Netherlands. Ron Onstenk, MD, Department of Orthopaedic Surgery, Groene Hart Hospital, Gouda, The Netherlands. Martijn Poeze, MD PhD, Department of Trauma Surgery, Maastricht University Medical Center, Maastricht, The Netherlands. Rudolf W. Poolman, MD PhD, Department of Orthopaedic Surgery, OLVG Hospital, Amsterdam, The Netherlands. Bas J. Punt, MD, Department of Surgery, Albert Schweitzer Hospital, Dordrecht, The Netherlands. Ewan D. Ritchie, MD, Department of Surgery, Alrijne Hospital, Leiderdorp, The Netherlands. W. Herbert Roerdink, MD PhD, Department of Surgery, Deventer Hospital, Deventer, The Netherlands. Gert R. Roukema, MD, Department of Surgery, Maasstad Hospital, Rotterdam, The Netherlands. Jan Bernard Sintenie, MD, Department of Surgery, Elkerliek Hospital, Helmond, The Netherlands. Nicolaj M.R. Soesman, MD, Department of Surgery, Franciscus Gasthuis & Vlietland, Schiedam, The Netherlands. Edgar J.T. Ten Holder, MD, Department of Orthopaedic Surgery, IJsselland Hospital, Capelle a/d IJssel, The Netherlands. Wim E. Tuinebreijer, MD PhD, Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. Maarten Van der Elst, MD PhD, Department of Surgery, Reinier de Graaf Gasthuis, Delft, The Netherlands. Frank H.W.M. Van der Heijden, MD PhD, Department of Surgery, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands. Frits M. Van der Linden, MD, Department of Surgery, Groene Hart Hospital, Gouda, The Netherlands. Peer Van der Zwaal, MD PhD, Trauma Unit, Haaglanden MC, The Hague, The Netherlands. Jan P. Van Dijk, MD, Department of Surgery, Hospital Gelderse Vallei, Ede, The Netherlands. Hans-Peter W. Van Jonbergen, MD PhD, Department of Orthopaedic Surgery, Deventer Hospital, Deventer, The Netherlands. Egbert J.M.M. Verleisdonk, MD PhD, Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands. Jos P.A.M. Vroemen, MD PhD, Department of Surgery, Amphia Hospital, Breda, The Netherlands. Marco Waleboer, MD, Department of Surgery, Admiraal De Ruyter Hospital, Goes, The Netherlands. Philippe Wittich, MD PhD, Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands. Wietse P. Zuidema, MD, Department of Trauma Surgery, Amsterdam University Medical Center, location VUmc, Amsterdam, The Netherlands. Medical students (Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands): Ahmed Al Khanim, Jelle E. Bousema, Kevin Cheng, Yordy Claes, J. Daniël Cnossen, Emmelie N. Dekker, Aron J.M. De Zwart, Priscilla A. Jawahier, Boudijn S.H. Joling, Cornelia (Marije) A.W. Notenboom, Jaap B. Schulte, Nina Theyskens, Gijs J.J. Van Aert, Boyd C.P. Van der Schaaf, Tim Van der Torre, Joyce Van Veldhuizen, Lois M.M. Verhagen, Maarten Verwer, Joris Vollbrandt.

Funding Information:
This project was supported by a grant from the Osteosynthesis and Trauma Care (OTC) Foundation (reference number 2013-DHEL). This organization was not involved in the study design, patient recruitment, data collection, data analysis, data interpretation, publication decisions, or in any aspect pertinent to this study.

Publisher Copyright:
© 2022, The Author(s).

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Cite this

Van Bergen, S. H., Van Lieshout, E. M. M., Mahabier, K. C., Geraerds, A. J. L. M., Polinder, S., Den Hartog, D., Verhofstad, M. H. J., the HUMMER Investigators, & Notenboom, M. (2023). Economic evaluation of operative versus nonoperative treatment of a humeral shaft fracture: economic analyses alongside a multicenter prospective cohort study (HUMMER). European Journal of Trauma and Emergency Surgery, 49(2), 929-938. Advance online publication. https://doi.org/10.1007/s00068-022-02160-1

@article{1416c705b52f4e9eae62e4994c74bbad,

title = "Economic evaluation of operative versus nonoperative treatment of a humeral shaft fracture: economic analyses alongside a multicenter prospective cohort study (HUMMER)",

abstract = "Purpose: Operative treatment of a humeral shaft fracture results in faster recovery than nonoperative treatment. The cost-effectiveness, in terms of costs per Quality-Adjusted Life Year (QALY) gained (Dutch threshold €20,000-€80,000) or minimal important change (MIC) in disability reduced (DASH 6.7), is unknown. The aim of this study was to determine cost-utility and cost-effectiveness of operative versus nonoperative treatment in adults with a humeral shaft fracture type 12A or 12B. Methods: This study was performed alongside a multicenter prospective cohort study. Costs for health care and lost productivity until one year after trauma were calculated. The incremental cost-utility ratio (ICUR) was reported in costs per QALY (based on the EuroQoL-5D-3L (EQ-5D)) gained. The incremental cost-effectiveness ratio (ICER) was reported in costs per MIC (based on the DASH score at three months) reduced. Results: Overall, 245 patients were treated operatively and 145 nonoperatively. In the operative group, the mean total costs per patient (€11,925 versus €8793; p < 0.001) and QALYs (0.806 versus 0.778; p < 0.001) were higher. The ICUR of operative treatment was €111,860 per QALY gained (i.e., €3132/0.028). The DASH was 7.3 points (p < 0.001) lower in the operative group. The ICER of operative treatment was €2880 per MIC in disability reduced (i.e., €3132/7.3*6.7). Conclusion: Due to the limited effect of treatment on quality of life measured with the EQ-5D, the ICUR of operative treatment (€111,860 per QALY gained) exceeds the threshold. However, the incremental costs of €2880 per clinically meaningful difference in DASH are much lower and suggest that operative treatment for a humeral shaft fracture is cost-effective.",

author = "{Van Bergen}, {Saskia H.} and {Van Lieshout}, {Esther M.M.} and Mahabier, {Kiran C.} and Geraerds, {Alexandra J.L.M.} and Suzanne Polinder and {Den Hartog}, Dennis and Verhofstad, {Michael H.J.} and {the HUMMER Investigators} and Ivo Beetz and Bolhuis, {Hugo W.} and Bos, {P. Koen} and Bronkhorst, {Maarten W.G.A.} and Bruijninckx, {Milko M.M.} and {De Haan}, Jeroen and Deenik, {Axel R.} and {Den Hoed}, {P. Ted} and Eversdijk, {Martin G.} and Goslings, {J. Carel} and Robert Haverlag and Heetveld, {Martin J.} and Kerver, {Albertus J.H.} and Kolkman, {Karel A.} and Leenhouts, {Peter A.} and Meylaerts, {Sven A.G.} and Ron Onstenk and Martijn Poeze and Poolman, {Rudolf W.} and Punt, {Bas J.} and Ritchie, {Ewan D.} and Roerdink, {W. Herbert} and Roukema, {Gert R.} and Sintenie, {Jan Bernard} and Soesman, {Nicolaj M.R.} and {Ten Holder}, {Edgar J.T.} and Tuinebreijer, {Wim E.} and {Van der Elst}, Maarten and Marco Waleboer and {Al Khanim}, Ahmed and Bousema, {Jelle E.} and Dekker, {Emmelie N.} and {De Zwart}, {Aron J.M.} and Joling, {Boudijn S.H.} and Schulte, {Jaap B.} and Nina Theyskens and {Van Aert}, {Gijs J.J.} and {Van der Schaaf}, {Boyd C.P.} and {Van der Torre}, Tim and {Van Veldhuizen}, Joyce and Verhagen, {Lois M.M.} and Maarten Verwer and Joris Vollbrandt and Marije Notenboom",

note = "Funding Information: HUMMER INVESTIGATORS: Local principal investigators and co-investigators: Ivo Beetz, MD PhD, Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. Hugo W. Bolhuis, MD, Department of Surgery, Gelre Hospital, Apeldoorn, The Netherlands. P. Koen Bos, MD PhD, Department of Orthopaedic Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. Maarten W.G.A. Bronkhorst, MD PhD, Trauma Unit, Haaglanden MC, The Hague, The Netherlands. Milko M.M. Bruijninckx, MD, Department of Surgery, IJsselland Hospital, Capelle a/d Ijssel, The Netherlands. Jeroen De Haan, MD PhD, Department of Surgery, Dijklanderziekenhuis, Hoorn, The Netherlands. Axel R. Deenik, MD PhD, Department of Orthopaedic Surgery, Haaglanden MC, The Hague, The Netherlands. P. Ted Den Hoed, MD PhD, Department of Surgery, Ikazia Hospital, Rotterdam, The Netherlands. Martin G. Eversdijk, MD, Department of Surgery, St. Jansdal Hospital, Harderwijk, The Netherlands. J. Carel Goslings, MD PhD, Trauma Unit Department of Surgery, Amsterdam University, Medical Center, location AMC, Amsterdam, The Netherlands. Robert Haverlag, MD, Department of Surgery, OLVG Hospital, Amsterdam, The Netherlands. Martin J. Heetveld, MD PhD, Department of Surgery, Spaarne Gasthuis, Haarlem, The Netherlands. Albertus J.H. Kerver, MD PhD, Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands. Karel A. Kolkman, MD, Department of Surgery, Rijnstate, Arnhem, The Netherlands. Peter A. Leenhouts, MD, Department of Surgery, Zaans Medical Center, Zaandam, The Netherlands. Sven A.G. Meylaerts, MD PhD, Trauma Unit, Haaglanden MC, The Hague, The Netherlands. Ron Onstenk, MD, Department of Orthopaedic Surgery, Groene Hart Hospital, Gouda, The Netherlands. Martijn Poeze, MD PhD, Department of Trauma Surgery, Maastricht University Medical Center, Maastricht, The Netherlands. Rudolf W. Poolman, MD PhD, Department of Orthopaedic Surgery, OLVG Hospital, Amsterdam, The Netherlands. Bas J. Punt, MD, Department of Surgery, Albert Schweitzer Hospital, Dordrecht, The Netherlands. Ewan D. Ritchie, MD, Department of Surgery, Alrijne Hospital, Leiderdorp, The Netherlands. W. Herbert Roerdink, MD PhD, Department of Surgery, Deventer Hospital, Deventer, The Netherlands. Gert R. Roukema, MD, Department of Surgery, Maasstad Hospital, Rotterdam, The Netherlands. Jan Bernard Sintenie, MD, Department of Surgery, Elkerliek Hospital, Helmond, The Netherlands. Nicolaj M.R. Soesman, MD, Department of Surgery, Franciscus Gasthuis & Vlietland, Schiedam, The Netherlands. Edgar J.T. Ten Holder, MD, Department of Orthopaedic Surgery, IJsselland Hospital, Capelle a/d IJssel, The Netherlands. Wim E. Tuinebreijer, MD PhD, Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. Maarten Van der Elst, MD PhD, Department of Surgery, Reinier de Graaf Gasthuis, Delft, The Netherlands. Frank H.W.M. Van der Heijden, MD PhD, Department of Surgery, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands. Frits M. Van der Linden, MD, Department of Surgery, Groene Hart Hospital, Gouda, The Netherlands. Peer Van der Zwaal, MD PhD, Trauma Unit, Haaglanden MC, The Hague, The Netherlands. Jan P. Van Dijk, MD, Department of Surgery, Hospital Gelderse Vallei, Ede, The Netherlands. Hans-Peter W. Van Jonbergen, MD PhD, Department of Orthopaedic Surgery, Deventer Hospital, Deventer, The Netherlands. Egbert J.M.M. Verleisdonk, MD PhD, Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands. Jos P.A.M. Vroemen, MD PhD, Department of Surgery, Amphia Hospital, Breda, The Netherlands. Marco Waleboer, MD, Department of Surgery, Admiraal De Ruyter Hospital, Goes, The Netherlands. Philippe Wittich, MD PhD, Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands. Wietse P. Zuidema, MD, Department of Trauma Surgery, Amsterdam University Medical Center, location VUmc, Amsterdam, The Netherlands. Medical students (Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands): Ahmed Al Khanim, Jelle E. Bousema, Kevin Cheng, Yordy Claes, J. Dani{\"e}l Cnossen, Emmelie N. Dekker, Aron J.M. De Zwart, Priscilla A. Jawahier, Boudijn S.H. Joling, Cornelia (Marije) A.W. Notenboom, Jaap B. Schulte, Nina Theyskens, Gijs J.J. Van Aert, Boyd C.P. Van der Schaaf, Tim Van der Torre, Joyce Van Veldhuizen, Lois M.M. Verhagen, Maarten Verwer, Joris Vollbrandt. Funding Information: This project was supported by a grant from the Osteosynthesis and Trauma Care (OTC) Foundation (reference number 2013-DHEL). This organization was not involved in the study design, patient recruitment, data collection, data analysis, data interpretation, publication decisions, or in any aspect pertinent to this study. Publisher Copyright: {\textcopyright} 2022, The Author(s).",

year = "2023",

month = apr,

doi = "10.1007/s00068-022-02160-1",

language = "English",

volume = "49",

pages = "929--938",

journal = "European Journal of Trauma and Emergency Surgery",

issn = "1863-9933",

publisher = "Springer International Publishing AG",

number = "2",

}

Van Bergen, SH , Van Lieshout, EMM , Mahabier, KC, Geraerds, AJLM, Polinder, S , Den Hartog, D , Verhofstad, MHJ, the HUMMER Investigators & Notenboom, M 2023, 'Economic evaluation of operative versus nonoperative treatment of a humeral shaft fracture: economic analyses alongside a multicenter prospective cohort study (HUMMER)', European Journal of Trauma and Emergency Surgery, vol. 49, no. 2, pp. 929-938. https://doi.org/10.1007/s00068-022-02160-1

Economic evaluation of operative versus nonoperative treatment of a humeral shaft fracture: economic analyses alongside a multicenter prospective cohort study (HUMMER). / Van Bergen, Saskia H.; Van Lieshout, Esther M.M.; Mahabier, Kiran C. et al.
In: European Journal of Trauma and Emergency Surgery, Vol. 49, No. 2, 04.2023, p. 929-938.

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

TY - JOUR

T1 - Economic evaluation of operative versus nonoperative treatment of a humeral shaft fracture

T2 - economic analyses alongside a multicenter prospective cohort study (HUMMER)

AU - Van Bergen, Saskia H.

AU - Van Lieshout, Esther M.M.

AU - Mahabier, Kiran C.

AU - Geraerds, Alexandra J.L.M.

AU - Polinder, Suzanne

AU - Den Hartog, Dennis

AU - Verhofstad, Michael H.J.

AU - the HUMMER Investigators

AU - Beetz, Ivo

AU - Bolhuis, Hugo W.

AU - Bos, P. Koen

AU - Bronkhorst, Maarten W.G.A.

AU - Bruijninckx, Milko M.M.

AU - De Haan, Jeroen

AU - Deenik, Axel R.

AU - Den Hoed, P. Ted

AU - Eversdijk, Martin G.

AU - Goslings, J. Carel

AU - Haverlag, Robert

AU - Heetveld, Martin J.

AU - Kerver, Albertus J.H.

AU - Kolkman, Karel A.

AU - Leenhouts, Peter A.

AU - Meylaerts, Sven A.G.

AU - Onstenk, Ron

AU - Poeze, Martijn

AU - Poolman, Rudolf W.

AU - Punt, Bas J.

AU - Ritchie, Ewan D.

AU - Roerdink, W. Herbert

AU - Roukema, Gert R.

AU - Sintenie, Jan Bernard

AU - Soesman, Nicolaj M.R.

AU - Ten Holder, Edgar J.T.

AU - Tuinebreijer, Wim E.

AU - Van der Elst, Maarten

AU - Waleboer, Marco

AU - Al Khanim, Ahmed

AU - Bousema, Jelle E.

AU - Dekker, Emmelie N.

AU - De Zwart, Aron J.M.

AU - Joling, Boudijn S.H.

AU - Schulte, Jaap B.

AU - Theyskens, Nina

AU - Van Aert, Gijs J.J.

AU - Van der Schaaf, Boyd C.P.

AU - Van der Torre, Tim

AU - Van Veldhuizen, Joyce

AU - Verhagen, Lois M.M.

AU - Verwer, Maarten

AU - Vollbrandt, Joris

AU - Notenboom, Marije

N1 - Funding Information: HUMMER INVESTIGATORS: Local principal investigators and co-investigators: Ivo Beetz, MD PhD, Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. Hugo W. Bolhuis, MD, Department of Surgery, Gelre Hospital, Apeldoorn, The Netherlands. P. Koen Bos, MD PhD, Department of Orthopaedic Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. Maarten W.G.A. Bronkhorst, MD PhD, Trauma Unit, Haaglanden MC, The Hague, The Netherlands. Milko M.M. Bruijninckx, MD, Department of Surgery, IJsselland Hospital, Capelle a/d Ijssel, The Netherlands. Jeroen De Haan, MD PhD, Department of Surgery, Dijklanderziekenhuis, Hoorn, The Netherlands. Axel R. Deenik, MD PhD, Department of Orthopaedic Surgery, Haaglanden MC, The Hague, The Netherlands. P. Ted Den Hoed, MD PhD, Department of Surgery, Ikazia Hospital, Rotterdam, The Netherlands. Martin G. Eversdijk, MD, Department of Surgery, St. Jansdal Hospital, Harderwijk, The Netherlands. J. Carel Goslings, MD PhD, Trauma Unit Department of Surgery, Amsterdam University, Medical Center, location AMC, Amsterdam, The Netherlands. Robert Haverlag, MD, Department of Surgery, OLVG Hospital, Amsterdam, The Netherlands. Martin J. Heetveld, MD PhD, Department of Surgery, Spaarne Gasthuis, Haarlem, The Netherlands. Albertus J.H. Kerver, MD PhD, Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands. Karel A. Kolkman, MD, Department of Surgery, Rijnstate, Arnhem, The Netherlands. Peter A. Leenhouts, MD, Department of Surgery, Zaans Medical Center, Zaandam, The Netherlands. Sven A.G. Meylaerts, MD PhD, Trauma Unit, Haaglanden MC, The Hague, The Netherlands. Ron Onstenk, MD, Department of Orthopaedic Surgery, Groene Hart Hospital, Gouda, The Netherlands. Martijn Poeze, MD PhD, Department of Trauma Surgery, Maastricht University Medical Center, Maastricht, The Netherlands. Rudolf W. Poolman, MD PhD, Department of Orthopaedic Surgery, OLVG Hospital, Amsterdam, The Netherlands. Bas J. Punt, MD, Department of Surgery, Albert Schweitzer Hospital, Dordrecht, The Netherlands. Ewan D. Ritchie, MD, Department of Surgery, Alrijne Hospital, Leiderdorp, The Netherlands. W. Herbert Roerdink, MD PhD, Department of Surgery, Deventer Hospital, Deventer, The Netherlands. Gert R. Roukema, MD, Department of Surgery, Maasstad Hospital, Rotterdam, The Netherlands. Jan Bernard Sintenie, MD, Department of Surgery, Elkerliek Hospital, Helmond, The Netherlands. Nicolaj M.R. Soesman, MD, Department of Surgery, Franciscus Gasthuis & Vlietland, Schiedam, The Netherlands. Edgar J.T. Ten Holder, MD, Department of Orthopaedic Surgery, IJsselland Hospital, Capelle a/d IJssel, The Netherlands. Wim E. Tuinebreijer, MD PhD, Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. Maarten Van der Elst, MD PhD, Department of Surgery, Reinier de Graaf Gasthuis, Delft, The Netherlands. Frank H.W.M. Van der Heijden, MD PhD, Department of Surgery, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands. Frits M. Van der Linden, MD, Department of Surgery, Groene Hart Hospital, Gouda, The Netherlands. Peer Van der Zwaal, MD PhD, Trauma Unit, Haaglanden MC, The Hague, The Netherlands. Jan P. Van Dijk, MD, Department of Surgery, Hospital Gelderse Vallei, Ede, The Netherlands. Hans-Peter W. Van Jonbergen, MD PhD, Department of Orthopaedic Surgery, Deventer Hospital, Deventer, The Netherlands. Egbert J.M.M. Verleisdonk, MD PhD, Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands. Jos P.A.M. Vroemen, MD PhD, Department of Surgery, Amphia Hospital, Breda, The Netherlands. Marco Waleboer, MD, Department of Surgery, Admiraal De Ruyter Hospital, Goes, The Netherlands. Philippe Wittich, MD PhD, Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands. Wietse P. Zuidema, MD, Department of Trauma Surgery, Amsterdam University Medical Center, location VUmc, Amsterdam, The Netherlands. Medical students (Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands): Ahmed Al Khanim, Jelle E. Bousema, Kevin Cheng, Yordy Claes, J. Daniël Cnossen, Emmelie N. Dekker, Aron J.M. De Zwart, Priscilla A. Jawahier, Boudijn S.H. Joling, Cornelia (Marije) A.W. Notenboom, Jaap B. Schulte, Nina Theyskens, Gijs J.J. Van Aert, Boyd C.P. Van der Schaaf, Tim Van der Torre, Joyce Van Veldhuizen, Lois M.M. Verhagen, Maarten Verwer, Joris Vollbrandt. Funding Information: This project was supported by a grant from the Osteosynthesis and Trauma Care (OTC) Foundation (reference number 2013-DHEL). This organization was not involved in the study design, patient recruitment, data collection, data analysis, data interpretation, publication decisions, or in any aspect pertinent to this study. Publisher Copyright: © 2022, The Author(s).

PY - 2023/4

Y1 - 2023/4

N2 - Purpose: Operative treatment of a humeral shaft fracture results in faster recovery than nonoperative treatment. The cost-effectiveness, in terms of costs per Quality-Adjusted Life Year (QALY) gained (Dutch threshold €20,000-€80,000) or minimal important change (MIC) in disability reduced (DASH 6.7), is unknown. The aim of this study was to determine cost-utility and cost-effectiveness of operative versus nonoperative treatment in adults with a humeral shaft fracture type 12A or 12B. Methods: This study was performed alongside a multicenter prospective cohort study. Costs for health care and lost productivity until one year after trauma were calculated. The incremental cost-utility ratio (ICUR) was reported in costs per QALY (based on the EuroQoL-5D-3L (EQ-5D)) gained. The incremental cost-effectiveness ratio (ICER) was reported in costs per MIC (based on the DASH score at three months) reduced. Results: Overall, 245 patients were treated operatively and 145 nonoperatively. In the operative group, the mean total costs per patient (€11,925 versus €8793; p < 0.001) and QALYs (0.806 versus 0.778; p < 0.001) were higher. The ICUR of operative treatment was €111,860 per QALY gained (i.e., €3132/0.028). The DASH was 7.3 points (p < 0.001) lower in the operative group. The ICER of operative treatment was €2880 per MIC in disability reduced (i.e., €3132/7.3*6.7). Conclusion: Due to the limited effect of treatment on quality of life measured with the EQ-5D, the ICUR of operative treatment (€111,860 per QALY gained) exceeds the threshold. However, the incremental costs of €2880 per clinically meaningful difference in DASH are much lower and suggest that operative treatment for a humeral shaft fracture is cost-effective.

AB - Purpose: Operative treatment of a humeral shaft fracture results in faster recovery than nonoperative treatment. The cost-effectiveness, in terms of costs per Quality-Adjusted Life Year (QALY) gained (Dutch threshold €20,000-€80,000) or minimal important change (MIC) in disability reduced (DASH 6.7), is unknown. The aim of this study was to determine cost-utility and cost-effectiveness of operative versus nonoperative treatment in adults with a humeral shaft fracture type 12A or 12B. Methods: This study was performed alongside a multicenter prospective cohort study. Costs for health care and lost productivity until one year after trauma were calculated. The incremental cost-utility ratio (ICUR) was reported in costs per QALY (based on the EuroQoL-5D-3L (EQ-5D)) gained. The incremental cost-effectiveness ratio (ICER) was reported in costs per MIC (based on the DASH score at three months) reduced. Results: Overall, 245 patients were treated operatively and 145 nonoperatively. In the operative group, the mean total costs per patient (€11,925 versus €8793; p < 0.001) and QALYs (0.806 versus 0.778; p < 0.001) were higher. The ICUR of operative treatment was €111,860 per QALY gained (i.e., €3132/0.028). The DASH was 7.3 points (p < 0.001) lower in the operative group. The ICER of operative treatment was €2880 per MIC in disability reduced (i.e., €3132/7.3*6.7). Conclusion: Due to the limited effect of treatment on quality of life measured with the EQ-5D, the ICUR of operative treatment (€111,860 per QALY gained) exceeds the threshold. However, the incremental costs of €2880 per clinically meaningful difference in DASH are much lower and suggest that operative treatment for a humeral shaft fracture is cost-effective.

UR - http://www.scopus.com/inward/record.url?scp=85143790816&partnerID=8YFLogxK

U2 - 10.1007/s00068-022-02160-1

DO - 10.1007/s00068-022-02160-1

M3 - Article

AN - SCOPUS:85143790816

SN - 1863-9933

VL - 49

SP - 929

EP - 938

JO - European Journal of Trauma and Emergency Surgery

JF - European Journal of Trauma and Emergency Surgery

IS - 2

ER -

Van Bergen SH , Van Lieshout EMM , Mahabier KC, Geraerds AJLM, Polinder S , Den Hartog D et al. Economic evaluation of operative versus nonoperative treatment of a humeral shaft fracture: economic analyses alongside a multicenter prospective cohort study (HUMMER). European Journal of Trauma and Emergency Surgery. 2023 Apr;49(2):929-938. Epub 2022 Dec 8. doi: 10.1007/s00068-022-02160-1

Economic evaluation of operative versus nonoperative treatment of a humeral shaft fracture: economic analyses alongside a multicenter prospective cohort study (HUMMER)

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