Cost analysis
fracture, numbness, loss of reduction, pain, carpal tunnel syndrome
REGRESSION, PRESSURE SORE, CARPAL TUNNEL SYNDROME
The costs of treatment consisted of additional visits to the hospital, imaging and other examinations, physical therapy, and operative treatment. The mean overall cost of treatment per patient in the VFUDC group was €1 307 and €717 in the FC group. Thus, the costs per patient of VFUDC were €590 (82%) higher than the costs of FC. The difference in median costs was €-156 (95% CI -303 to -9), again in favor of FC. The difference in means in a linear regression model of 15D at 2 years was 0.006 points (95% CI -0,05 to 0,06) and did not reach the MCID. Based on 15D at 2 years, FC produced 0.012 more QALYs compared to VFUDC.The mean number of additional visits to hospital per patient was 1.98 in the VFUDC group and 1.64 in the FC group. Additional visits were 21% more frequent in VFUDC than in FC group. The reason for additional visits in the hospital was contact from the patient due to pain, pressure sores and/or numbness of fingers. Further examinations and procedures were done as needed according to the evaluation by a consultant surgeon. The overall costs of these visits and associated additional imaging or other examinations related to the fracture were €443 per patient in the VFUDC group and €358 per patient in the FC group. The rate of patients who had received physical therapy after 24 months was 57% (25) in the VFUDC group and 37% (14) in the FC group. The total number of physical therapy contacts was 224 in the VFUDC group and 63 in the FC group. The mean number of physical therapy contacts was 10.4 for the VFUDC and 4.5 for the FC group and the median were 6 and 3, respectively. The costs of physical therapy were €17 472 in the VFUDC group and €4 914 euros in the FC group. The cost of physical therapy per patient was €397 in the VFUDC and €133 in the FC group.A total of 6 operations were performed in the VFUDC group due to loss of reduction within the intended casting period. All operations were performed using an anatomic volar locking plate (VLP). In the FC group, 4 operations were performed. No corrective osteotomies were performed in the FC group, whereas 2 osteotomies were performed in the VFUDC group during the two-year follow-up period. Two patients in the VFUDC group had electroneuromyography performed after the casting period ended, but none of the patients needed surgery due to carpal tunnel syndrome and no carpal tunnel release operations were performed during the follow-up period. The cost of a surgical operation for fracture was €2 092, and the cost of a corrective osteotomy was €3 997 euros. The cost of operations per patient in the VFUDC group was €467 and €226 in the FC group. Delayed surgery increased the cost of operative care in the VFUDC group by €182 per patient. Excluding the cost of surgeries and only considering additional costs due to physical therapy and additional visits and examinations, the overall cost of treatment per patient was 840 euros per patient in the VFUDC and 490 euros in the FC group, a difference of 71% between groups.