Injury · 2026
Early cost-effectiveness analysis of continuous compartment pressure monitoring modelled in patients with a fracture of the tibial diaphysis.
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Duckworth Andrew D, Williamson Thomas R, Harper Sam, Buckley Ciara, Sackier Jonathan, Bouklouch Yasser
Аннотация
BACKGROUND: The aim of this study was to model the cost-effectiveness of continuous pressure monitoring (CPM) in a hypothetical cohort of patients with a fracture of the tibial diaphysis.
METHODS: Decision-tree model structure was utilised to capture 60-day costs and health related quality of life (HRQoL) following a fracture of the tibial diaphysis. Depending on the effectiveness of the diagnostic method, patients were allocated to one of six validated outcome grades for acute compartment syndrome (ACS). Mean costs, utilities, and hospital length of stay were applied to each of these grades. Parameter inputs and costs were obtained from UK-specific published literature where possible. Analysis was performed from the UK National Health Service (NHS) perspective to determine the estimated impact in a hypothetical cohort of 1000 patients with a tibial diaphyseal fracture using CPM versus current standard diagnostic methods for ACS.
RESULTS: Base case results indicated that the utilisation of CPM was associated with significant cost savings of £ 452/patient when compared with the standard care of clinical assessment and/or single point pressure measurement (SPPM). An associated additional 2733 NHS bed days were saved. Incremental quality-adjusted life year (QALY) gain of 0.02 was found, resulting in a dominant incremental cost effectiveness ratio (ICER). When analyses were performed considering different diagnostic outcome grade distributions and for a varying time horizon, CPM was found to have both increased cost savings and cost-efficacy.
CONCLUSIONS: This early economic model suggests that CPM of patients with a tibial diaphyseal fracture could be a cost-effective diagnostic option, although more data is required in order to validate the model assumptions. However, given the established evidence demonstrating the superior diagnostic performance characteristics of CPM when compared to clinical symptoms and/or SPPM, this economic data adds further support to the use of CPM as an essential diagnostic adjunct in patients at risk of ACS.
METHODS: Decision-tree model structure was utilised to capture 60-day costs and health related quality of life (HRQoL) following a fracture of the tibial diaphysis. Depending on the effectiveness of the diagnostic method, patients were allocated to one of six validated outcome grades for acute compartment syndrome (ACS). Mean costs, utilities, and hospital length of stay were applied to each of these grades. Parameter inputs and costs were obtained from UK-specific published literature where possible. Analysis was performed from the UK National Health Service (NHS) perspective to determine the estimated impact in a hypothetical cohort of 1000 patients with a tibial diaphyseal fracture using CPM versus current standard diagnostic methods for ACS.
RESULTS: Base case results indicated that the utilisation of CPM was associated with significant cost savings of £ 452/patient when compared with the standard care of clinical assessment and/or single point pressure measurement (SPPM). An associated additional 2733 NHS bed days were saved. Incremental quality-adjusted life year (QALY) gain of 0.02 was found, resulting in a dominant incremental cost effectiveness ratio (ICER). When analyses were performed considering different diagnostic outcome grade distributions and for a varying time horizon, CPM was found to have both increased cost savings and cost-efficacy.
CONCLUSIONS: This early economic model suggests that CPM of patients with a tibial diaphyseal fracture could be a cost-effective diagnostic option, although more data is required in order to validate the model assumptions. However, given the established evidence demonstrating the superior diagnostic performance characteristics of CPM when compared to clinical symptoms and/or SPPM, this economic data adds further support to the use of CPM as an essential diagnostic adjunct in patients at risk of ACS.