• Adam M Pearson, Anna N A Tosteson, Kenneth J Koval, Michael D McKee, Robert V Cantu, John E Bell, and Milena Vicente.
• Dartmouth-Hitchcock Medical Center, Lebanon, NH 03755, USA. adam.pearson@hitchcock.org
• J Orthop Trauma. 2010 Jul 1; 24 (7): 426-33.

ObjectivesTo determine the cost-effectiveness of open reduction internal fixation (ORIF) of displaced, midshaft clavicle fractures in adults.DesignFormal cost-effectiveness analysis based on a prospective, randomized, controlled trial.SettingEight hospitals in Canada (seven university-affiliated and one community hospital).Patients/ParticipantsOne hundred thirty-two adults with acute, completely displaced, midshaft clavicle fractures.InterventionClavicle ORIF versus nonoperative treatment.Main Outcome MeasurementsUtilities derived from SF-6D.ResultsThe base case cost per quality-adjusted life-year (QALY) gained for ORIF was $65,000. Cost-effectiveness improved to $28,150/QALY gained when the functional benefit from ORIF was assumed to be permanent with cost per QALY gained falling below $50,000 when the functional advantage persisted for 9.3 years or more. In other sensitivity analyses, the cost per QALY gained for ORIF fell below $50,000 when ORIF cost less than $10,465 (base case cost $13,668) or the long-term utility difference between nonoperative treatment and ORIF was greater than 0.034 (base case difference 0.014). Short-term disutility associated with fracture healing also affected cost-effectiveness with the cost per QALY gained for ORIF falling below $50,000 when the utility of a fracture treated nonoperatively before union was less than 0.617 (base case utility 0.706) or when nonoperative treatment increased the time to union by 20 weeks (base case difference 12 weeks).ConclusionsThe cost-effectiveness of ORIF after acute clavicle fracture depended on the durability of functional advantage for ORIF compared with nonoperative treatment. When functional benefits persisted for more than 9 years, ORIF had a favorable value compared with many accepted health interventions.

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