Reduction of routine use of radiography in patients with ankle fractures leads to lower costs and has no impact on clinical outcome: an economic evaluation

van Gerven, P.; van Dongen, J. M.; Rubinstein, S. M.; Termaat, M. F.; El Moumni, M.; Zuidema, W. P.; Krijnen, P.; Schipper, I. B.; van Tulder, M. W.

doi:10.1186/s12913-020-05725-1

Table 3 Differences in pooled mean costs and effects (95% Confidence intervals), incremental cost-effectiveness ratios, and the distribution of incremental cost-effect pairs around the quadrants of the cost-effectiveness planes for reduced imaging compared to usual care

From: Reduction of routine use of radiography in patients with ankle fractures leads to lower costs and has no impact on clinical outcome: an economic evaluation

Analysis	Sample size		Outcome measure	∆C (95% CI)	∆E (95% CI)	ICER	Distribution CE-plane (%)
	Control	Intervention		€	Points	€/point	NE	SE	SW	NW
Main analysis - Imputed dataset	128	118	QALYs (Range: 0–1)	131 (− 3039 to 3928)	− 0.008 (− 0.04 to 0.03)	−16,198	17.4	14.4	32.1	36.0
Main analysis - Imputed dataset	128	118	OMAS (Range: 0–100)	131 (− 3039 to 3928)	0.73 (− 5.29 to 6.76)	178	21.4	31.8	15.0	25.8
SA1 – Complete cases	29	23	QALYs (Range: 0–1)	1242 (− 7949 to 6447)	−0.014 (− 0.06 to 0.04)	−86,988	46.0	7.5	10.9	35.6
	29	23	OMAS (Range: 0–100)	1242 (−7949 to 6447)	3.04 (− 5.82 to 11.89)	409	70.1	16.2	2.8	10.8
SA2 – QALY 1 VS QALY 2	128	118	QALYs (Range: 0–1)	131 (−3039 to 3947)	−0.013 (− 0.05 to 0.02)	− 10,394	8.3	15.9	30.8	45.0
SA3 – Human capital approach	128	118	QALYs (Range: 0–1)	383 (− 2900 to 4365)	−0.008 (− 0.04 to 0.03)	−47,311	19.2	13.2	29.8	39.9
	128	118	OMAS (Range: 0–100)	383 (− 2900 to 4365)	0.73 (− 5.29 to 6.75)	527	30.6	28.9	13.2	27.4
SA4 – Healthcare perspective	128	118	QALYs (Range: 0–1)	− 89 (− 2386 to 3287)	−0.008 (− 0.04 to 0.03)	11,052	14.3	17.2	36.4	32.1
	128	118	OMAS (Range: 0–100)	−89 (−2386 to 3287)	0.73 (−5.29 to 6.75)	−121	23.6	36.2	17.4	22.8
SA5 – Conservative treatment	51	41	QALYs (Range: 0–1)	− 2425 (− 9691 to 1223)	−0.03 (− 0.09 to 0.02)	74,883	3.7	8.1	66.2	22.0
SA5 – Conservative treatment	51	41	OMAS (Range: 0–100)	−2425 (− 9691 to 1223)	− 1.60 (−10.49 to 7.30)	1519	6.2	28.5	45.5	19.8
SA6 – Operative treatment	77	77	QALYs (Range: 0–1)	1432 (− 3007 to 6706)	0.001 (−0.04 to 0.04)	1,504,404	39.0	15.5	14.7	30.9
	77	77	OMAS (Range: 0–100)	1432 (−3007 to 6706)	1.51 (−5.07 to 8.08)	951	50.6	24.7	4.3	20.4

SA Sensitivity analysis; QALYs Quality Adjusted Life Years; OMAS Olerud and Molander Ankle Score; ∆C Difference in cost; ∆E Difference in effect; ICER Incremental Cost Effectiveness Ratio; CE- plane Cost Effectiveness plane; NE North east part of the CE-plane (representing an intervention that is more costly, but more effective); SE South east part of the CE-plane (representing an intervention that is cheaper, and more effective); SW South west part of the CE-plane (representing an intervention that is cheaper, but less effective); NW North west part of the CE-plane (representing an intervention that is both more costly and less effective)

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