Cost-effectiveness of operative versus nonoperative treatment of lateral compression type 1 pelvic fractures

IF 2 3区医学 Q3 CRITICAL CARE MEDICINE

Injury-International Journal of the Care of the Injured Pub Date : 2025-08-26 DOI:10.1016/j.injury.2025.112723

Soham Ghoshal , Tynan Friend , Michael Gustin , Alexander R. Farid , Derek S. Stenquist , Nishant Suneja , Michael J. Weaver , Arvind G. Von Keudell

{"title":"Cost-effectiveness of operative versus nonoperative treatment of lateral compression type 1 pelvic fractures","authors":"Soham Ghoshal , Tynan Friend , Michael Gustin , Alexander R. Farid , Derek S. Stenquist , Nishant Suneja , Michael J. Weaver , Arvind G. Von Keudell","doi":"10.1016/j.injury.2025.112723","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Lateral compression type 1 (LC1) pelvic fractures are common injuries with ongoing debate regarding the cost-effectiveness of operative versus non-operative treatment. The goal of this study is to evaluate the cost-effectiveness of operative versus non-operative management for lateral compression type 1 (LC1) pelvic fractures, using pain (Brief Pain Inventory, BPI) and functional recovery (Majeed Pelvic Score, MPS) as outcome measures across early follow-up intervals.</div></div><div><h3>Methods</h3><div>A decision tree model was developed to analyze the costs and outcomes of operative and non-operative management for LC1 fractures. Costs were derived from Medicare reimbursement rates, and probabilities were informed by clinical data and expert opinion. BPI and MPS scores were used as proxies for utility, with incremental cost-effectiveness ratios (ICERs) calculated at 2, 6, and 12-week follow-ups. An ICER exceeding the willingness-to-pay (WTP) threshold of $50,000 indicated that non-operative management was the more cost-effective option. Sensitivity analyses explored the utility improvements required for operative treatment to meet the WTP threshold of $50,000 per meaningful change in BPI or MPS.</div></div><div><h3>Results</h3><div>Operative management was cost-effective for early pain relief, with an ICER of $33,466.08 per meaningful change in BPI at 2 weeks. However, it exceeded the WTP threshold at 6 weeks ($68,632.04) and only approached cost-effectiveness again at 12 weeks ($50,828.58). Using MPS, operative management was found to be cost-effective at 12 weeks ($44,992.90), but not at 2 or 6 weeks. Sensitivity analyses demonstrated that small utility gains could make operative management cost-effective at intermediate follow-up intervals.</div></div><div><h3>Conclusion</h3><div>Operative management of LC1 fractures may offer early cost-effective pain relief and possible delayed cost-effective functional recovery, particularly by 12 weeks. These findings may support surgical intervention for patients prioritizing rapid recovery by 12 weeks, but careful patient selection remains critical.</div></div><div><h3>Level of evidence</h3><div>Level 3.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 11","pages":"Article 112723"},"PeriodicalIF":2.0000,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Injury-International Journal of the Care of the Injured","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0020138325005819","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Lateral compression type 1 (LC1) pelvic fractures are common injuries with ongoing debate regarding the cost-effectiveness of operative versus non-operative treatment. The goal of this study is to evaluate the cost-effectiveness of operative versus non-operative management for lateral compression type 1 (LC1) pelvic fractures, using pain (Brief Pain Inventory, BPI) and functional recovery (Majeed Pelvic Score, MPS) as outcome measures across early follow-up intervals.

Methods

A decision tree model was developed to analyze the costs and outcomes of operative and non-operative management for LC1 fractures. Costs were derived from Medicare reimbursement rates, and probabilities were informed by clinical data and expert opinion. BPI and MPS scores were used as proxies for utility, with incremental cost-effectiveness ratios (ICERs) calculated at 2, 6, and 12-week follow-ups. An ICER exceeding the willingness-to-pay (WTP) threshold of $50,000 indicated that non-operative management was the more cost-effective option. Sensitivity analyses explored the utility improvements required for operative treatment to meet the WTP threshold of $50,000 per meaningful change in BPI or MPS.

Results

Operative management was cost-effective for early pain relief, with an ICER of $33,466.08 per meaningful change in BPI at 2 weeks. However, it exceeded the WTP threshold at 6 weeks ($68,632.04) and only approached cost-effectiveness again at 12 weeks ($50,828.58). Using MPS, operative management was found to be cost-effective at 12 weeks ($44,992.90), but not at 2 or 6 weeks. Sensitivity analyses demonstrated that small utility gains could make operative management cost-effective at intermediate follow-up intervals.

Conclusion

Operative management of LC1 fractures may offer early cost-effective pain relief and possible delayed cost-effective functional recovery, particularly by 12 weeks. These findings may support surgical intervention for patients prioritizing rapid recovery by 12 weeks, but careful patient selection remains critical.

Level of evidence

Level 3.

查看原文本刊更多论文

手术与非手术治疗侧压迫型1型骨盆骨折的成本-效果比较

背景：侧位压迫型1 （LC1）骨盆骨折是一种常见的损伤，关于手术与非手术治疗的成本-效果一直存在争议。本研究的目的是评估手术与非手术治疗侧压型1 （LC1）骨盆骨折的成本效益，使用疼痛（Brief pain Inventory， BPI）和功能恢复（Majeed骨盆评分，MPS）作为早期随访期间的结果测量指标。方法采用决策树模型分析LC1骨折手术和非手术治疗的成本和效果。成本来源于医疗保险报销率，概率由临床数据和专家意见决定。BPI和MPS评分作为效用的代理，在随访2周、6周和12周时计算增量成本-效果比（ICERs）。ICER超过50,000美元的支付意愿阈值表明非手术管理是更具成本效益的选择。敏感性分析探讨了手术治疗所需的效用改善，以达到每BPI或MPS有意义变化50,000美元的WTP阈值。结果手术治疗对于早期疼痛缓解具有成本效益，2周时每BPI有意义变化的ICER为33,466.08美元。然而，它在6周时超过了WTP阈值（68,632.04美元），在12周时才再次接近成本效益（50,828.58美元）。使用MPS，手术管理在12周时具有成本效益（$44,992.90），但在2周或6周时则没有成本效益。敏感性分析表明，在中期随访期间，小的效用增益可以使手术管理具有成本效益。结论LC1骨折的手术治疗可在早期提供具有成本效益的疼痛缓解，并可能延迟具有成本效益的功能恢复，特别是在12周后。这些发现可能支持手术干预优先考虑12周快速恢复的患者，但谨慎的患者选择仍然至关重要。证据等级：3级。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Injury-International Journal of the Care of the Injured 医学-急救医学

CiteScore

4.00

自引率

8.00%

发文量

699

审稿时长

96 days

期刊介绍： Injury was founded in 1969 and is an international journal dealing with all aspects of trauma care and accident surgery. Our primary aim is to facilitate the exchange of ideas, techniques and information among all members of the trauma team.