CHOOSING A STRATEGY FOR THE DIAGNOSTIC MANAGEMENT OF SUSPECTED SCAPHOID FRACTURE - A COST-EFFECTIVENESS ANALYSIS

To assess the cost-effectiveness of various strategies for the diagnos tic management of clinically suspected scaphoid fracture, a decision-a nalytic model was built to evaluate three strategies and to compare th em with a (clairvoyant) reference diagnostic management strategy. Meth ods: Evaluated strategies were: (A) repeated radiography up to 2 wk; ( B) repeat radiography up to 6 wk; and (C) radiography, followed by bon e scintigraphy in patients with negative initial radiographs. Therapy consisted of 12 wk of immobilization for a radiographically or scintig raphically proven fracture. Diagnostic costs, therapeutic costs, perio d of immobilization and nonunion rate were calculated for all three st rategies. Estimates were derived from a descriptive management study u sing bone scintigraphy and available literature. Sensitivity analyses were performed. Results: Overall costs were 273.7, 317.7 and 316.1 Eur opean Currency Units (ECU) for Strategies A, B and C, respectively (1 ECU = 1.15 U.S. dollar). Strategy B led to the longest average period of immobilization (8.6 wk), while Strategy A resulted in the highest n onunion rate (4.7%). The costs per nonunion saved for the additional u se of bone scintigraphy (Strategy C) was ECU 2618 when compared to Str ategy A. Conclusion: The use of bone scintigraphy in the diagnostic ma nagement of scaphoid fractures is accurate, convenient for patients an d cost-effective.