COST-EFFECTIVENESS ANALYSIS OF OPEN REDUCTION NONRIGID FIXATION AND OPEN REDUCTION RIGID FIXATION TO TREAT MANDIBULAR FRACTURES

Objectives. When open reduction and internal fixation is indicated for the management of mandibular fractures, it is generally agreed that n onrigid fixation and rigid fixation represent acceptable treatment alt ernatives. Opinions vary, however, regarding the cost-effectiveness of the two alternatives. The purpose of this study was to compare the co sts of these treatments of mandibular fractures that required open red uction and internal fixation. Study design. Cost-effectiveness analysi s was used to determine the most efficient resource used to treat mand ibular fractures requiring open reduction and internal fixation. Cost- effectiveness was defined as the treatment charges per successfully tr eated patient. Data were collected retrospectively from patients with mandibular fractures treated between 1991 and 1994. The patient's medi cal record and hospital billing record were used as data sources. To e stimate treatment charges, the sample was divided into three groups: ( 1) group 1, patients treated with nonrigid fixation without postoperat ive complications, (2) group 2, patients treated with rigid fixation w ithout postoperative complications, and (3) group 3, patients treated with either procedure who had postoperative complications. The study v ariables were grouped into two categories: clinical information and ch arges. Treatment charges for both treatments were estimated and compar ed. Results. Data were collected for 12 patients in group 1 and 11 pat ients in group 2. Costs for rigid fixation averaged $1,468 more per pa tient than for nonrigid fixation in uncomplicated cases. There were 11 patients in group 3. The average cost to treat a postoperative compli cation was $11,637. Given the institution-specific treatment cost and the probability of complications, rigid fixation was a more cost-effec tive treatment than nonrigid fixation. Conclusion. Cost estimates for treating mandibular fractures may vary widely depending on practice pa tterns and complication rates. Despite these cost variations, one may determine the most cost-effective treatment alternative by estimating treatment costs of both uncomplicated and complicated cases and the po stoperative complication rate.