Biomaterial Database

Choosing a strategy for the diagnostic management of suspected scaphoid fracture: a cost-effectiveness analysis. 1995

M M Tiel-van Buul, and T H Broekhuizen, and E J van Beek, and P M Bossuyt

Academic Medical Center, University of Amsterdam, The Netherlands.

To assess the cost-effectiveness of various strategies for the diagnostic management of clinically suspected scaphoid fracture, a decision-analytic model was built to evaluate three strategies and to compare them with a (clairvoyant) reference diagnostic management strategy. METHODS Evaluated strategies were: (A) repeated radiography up to 2 wk; (B) repeat radiography up to 6 wk; and (C) radiography, followed by bone scintigraphy in patients with negative initial radiographs. Therapy consisted of 12 wk of immobilization for a radiographically or scintigraphically proven fracture. Diagnostic costs, therapeutic costs, period of immobilization and nonunion rate were calculated for all three strategies. Estimates were derived from a descriptive management study using bone scintigraphy and available literature. Sensitivity analyses were performed. RESULTS Overall costs were 273.7, 317.7 and 316.1 European 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 nonunion rate (4.7%). The costs per nonunion saved for the additional use of bone scintigraphy (Strategy C) was ECU 2618 when compared to Strategy A. CONCLUSIONS The use of bone scintigraphy in the diagnostic management of scaphoid fractures is accurate, convenient for patients and cost-effective.

UI	MeSH Term	Description	Entries
D011859	Radiography	Examination of any part of the body for diagnostic purposes by means of X-RAYS or GAMMA RAYS, recording the image on a sensitized surface (such as photographic film).	Radiology, Diagnostic X-Ray,Roentgenography,X-Ray, Diagnostic,Diagnostic X-Ray,Diagnostic X-Ray Radiology,X-Ray Radiology, Diagnostic,Diagnostic X Ray,Diagnostic X Ray Radiology,Diagnostic X-Rays,Radiology, Diagnostic X Ray,X Ray Radiology, Diagnostic,X Ray, Diagnostic,X-Rays, Diagnostic
D011877	Radionuclide Imaging	The production of an image obtained by cameras that detect the radioactive emissions of an injected radionuclide as it has distributed differentially throughout tissues in the body. The image obtained from a moving detector is called a scan, while the image obtained from a stationary camera device is called a scintiphotograph.	Gamma Camera Imaging,Radioisotope Scanning,Scanning, Radioisotope,Scintigraphy,Scintiphotography,Imaging, Gamma Camera,Imaging, Radionuclide
D002348	Carpal Bones	The eight bones of the wrist: SCAPHOID BONE; LUNATE BONE; TRIQUETRUM BONE; PISIFORM BONE; TRAPEZIUM BONE; TRAPEZOID BONE; CAPITATE BONE; and HAMATE BONE.	Bone, Carpal,Bones, Carpal,Carpal Bone
D002370	Casts, Surgical	Dressings made of fiberglass, plastic, or bandage impregnated with plaster of paris used for immobilization of various parts of the body in cases of fractures, dislocations, and infected wounds. In comparison with plaster casts, casts made of fiberglass or plastic are lightweight, radiolucent, able to withstand moisture, and less rigid.	Fiberglass Casts,Plaster Casts,Plastic Casts,Cast, Surgical,Surgical Cast,Surgical Casts,Cast, Fiberglass,Cast, Plaster,Cast, Plastic,Casts, Fiberglass,Casts, Plaster,Casts, Plastic,Fiberglass Cast,Plaster Cast,Plastic Cast
D003362	Cost-Benefit Analysis	A method of comparing the cost of a program with its expected benefits in dollars (or other currency). The benefit-to-cost ratio is a measure of total return expected per unit of money spent. This analysis generally excludes consideration of factors that are not measured ultimately in economic terms. In contrast a cost effectiveness in general compares cost with qualitative outcomes.	Cost and Benefit,Cost-Benefit Data,Benefits and Costs,Cost Benefit,Cost Benefit Analysis,Cost-Utility Analysis,Costs and Benefits,Economic Evaluation,Marginal Analysis,Analyses, Cost Benefit,Analysis, Cost Benefit,Analysis, Cost-Benefit,Analysis, Cost-Utility,Analysis, Marginal,Benefit and Cost,Cost Benefit Analyses,Cost Benefit Data,Cost Utility Analysis,Cost-Benefit Analyses,Cost-Utility Analyses,Data, Cost-Benefit,Economic Evaluations,Evaluation, Economic,Marginal Analyses
D003661	Decision Support Techniques	Mathematical or statistical procedures used as aids in making a decision. They are frequently used in medical decision-making.	Decision Analysis,Decision Modeling,Models, Decision Support,Analysis, Decision,Decision Aids,Decision Support Technics,Aid, Decision,Aids, Decision,Analyses, Decision,Decision Aid,Decision Analyses,Decision Support Model,Decision Support Models,Decision Support Technic,Decision Support Technique,Model, Decision Support,Modeling, Decision,Technic, Decision Support,Technics, Decision Support,Technique, Decision Support,Techniques, Decision Support
D005592	Fracture Fixation	The use of metallic devices inserted into or through bone to hold a fracture in a set position and alignment while it heals.	Skeletal Fixation,Fracture Reduction,Fixation, Fracture,Fixation, Skeletal,Fixations, Fracture,Fixations, Skeletal,Fracture Fixations,Fracture Reductions,Reduction, Fracture,Reductions, Fracture,Skeletal Fixations
D005599	Fractures, Ununited	A fracture in which union fails to occur, the ends of the bone becoming rounded and eburnated, and a false joint occurs. (Stedman, 25th ed)	Fracture, Ununited,Ununited Fracture,Ununited Fractures
D006801	Humans	Members of the species Homo sapiens.	Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D012680	Sensitivity and Specificity	Binary classification measures to assess test results. Sensitivity or recall rate is the proportion of true positives. Specificity is the probability of correctly determining the absence of a condition. (From Last, Dictionary of Epidemiology, 2d ed)	Specificity,Sensitivity,Specificity and Sensitivity