The Use Of 6- Axis External Fixa5on Is More Cost- Effec5ve Than Ilizarov For Canadian Health Care Centres

Transcription

1 The Use Of 6- Axis External Fixa5on Is More Cost- Effec5ve Than Ilizarov For Canadian Health Care Centres Khalid Alkhelaifi MD, Elisabeth Leblanc, MSc MD FRCSC Mohammad Alzahrani MD; Karine Perreault MSc, Marie Gdalevitch MD FRCSC

2 DISCLOSURES Senior author is an educa5onal consultant for Smith and Nephew

3 INTRODUCTION CIRCULAR EXTERNAL FIXATION Limb lengthening And Or Deformity correction Post-Traumatic Dysplastic Congenital Developmental Pathologic Ilizarov 6-Axis EF (TSF)

4 ILIZAROV Important innova5on in limb reconstruc5on Rings, threaded rods and hinges Difficulty in mul5- planar and rota5onal correc5ons Increase need to return to OR for adjustments

5 TAYLOR SPATIAL FRAME Computer assisted 6- axis deformity correc5on EF Mul5- planar and rota5onal deformity correc5on More accurate correc5ons Decreases return to OR

6 ILIZAROV VS. TSF ILIZAROV RING FIXATOR Difficulty with multiplanar corrections Increase need to return to OR for frame adjustments Gold standard in Canada due to lower cost of equipment Mean unit cost : 1600$ TSF (6 axis EF) Mul6- planar correc6ons Improved accuracy Decreased complica6ons Limited use in Canada due to cost Standard in US Mean unit cost: 8000$

7 CANADIAN HEALTH CARE SYSTEM Publicly- funded Elevated implant costs = limit their poten5al use Difficult to get hospitals to approve budgets for 6 axis EF secondary to its cost OBJECTIVE Determine if the use of the TSF (or 6- axis EF) is cost- effeceve given the inieal implant cost?

8 COST- EFFECTIVENESS Is an economic evalua5on that determines both the cost and health outcomes of alterna5ve interven5on strategies: Ilizarov vs. TSF GAIN IN HEALTH COST ASSOCIATED Choose the most cost- effec5ve fixator from the perspec5ve of a Hospital in the Canadian Health Care System

9 METHODS Shriners Hospital Montreal Deformity and LLD cases from : 70 cases 11 excluded (clubfeet) 59 included 30 TSF 29 Ilizarov Total treatment cost per paeent Included Initial admission and OR time Implants Readmission Reoperation (for complications or readjustments) Excluded Surgeon / anesthetist fees (not paid by hospital) Complications not requiring OR

10 RESULTS Per patient Implant Cost differeneal Health benefits IniEal procedure Added procedures Admission Opera5ng room Re- Admission Return to OR TOTAL TREATMENT Favorable to TSF Unfavorable to TSF Neutral

11 RESULTS Per patient Cost differeneal Health benefits Implant + $6,400 Increased accuracy IniEal procedure Added procedures Admission Opera5ng room Re- Admission Return to OR TOTAL TREATMENT Favorable to TSF Unfavorable to TSF Neutral

12 RESULTS Per patient Cost differeneal Health benefits Implant + $6,400 Increased accuracy IniEal procedure Added procedures Admission No difference No difference Opera5ng room Re- Admission Return to OR No difference No difference TOTAL TREATMENT Favorable to TSF Unfavorable to TSF Neutral

13 RESULTS Per patient Cost of readmission Cost differeneal Health benefits Implant + $6,400 Increased accuracy IniEal procedure Added procedures Admission No difference No difference Opera5ng room CAD No difference No difference Re- Admission - $566,08-1,4 days saved per pa5ent Return to OR TOTAL TREATMENT TSF Ilizarov Favorable to TSF Unfavorable to TSF Neutral

14 RESULTS Per patient Cost Cost differeneal OR returns Health benefits Implant + $6,400 Increased accuracy IniEal procedure Added procedures Admission No difference No difference Opera5ng room No difference No difference Re- Admission - $566,08-1,4 days saved per pa5ent CAD Return to OR - $581, hrs saved per pa5ent TOTAL TREATMENT Favorable to TSF Unfavorable to TSF Neutral TSF Ilizarov

15 Per patient RESULTS Total cost and implant re- use Cost differeneal Health benefits Implant + $6,400 Increased Ilizarov accuracy TSF IniEal procedure Added procedures Admission No difference No difference Total cost (CAD) Opera5ng room No difference No difference Re- Admission - $566-1,4 days saved per pa5ent Return to OR - $ hrs saved per pa5ent TOTAL TREATMENT + $3,763 (single use) No difference (used twice) Favorable to TSF Unfavorable to TSF Neutral Implant reuse

16 Per patient RESULTS Complica5on rate Cost differeneal Health benefits IniEal procedure Added procedures Implant + $6,400 é accuracy Admission No difference No difference Number of complica5ons Opera5ng room TOTAL TREATMENT No difference No difference Re- Admission - $566-1,4 days Return to OR - $ hrs + $3,763 (single use) No difference (used twice) ê complica5ons Favorable to TSF Unfavorable to TSF Neutral TSF Ilizarov

17 CONCLUSION Re- admission, return to OR and complica5on rates were all significantly lower in the TSF TSF Cost- effec5ve? = YES! Clear added health benefits with no significant difference in cost if implants are used twice In Canada re- use frames For Canadian Hospitals 6- axis EF is a cost- effeceve solueon for limb reconstruceon

18 DISCUSSION Is 6- axis EF cost- effec5ve for single use? Single use is $3 763 more expensive but Does not account for: Surgeon and anaesthe5st fees for each OR return Opportunity cost of the OR Socio- economic cost to the pa5ent Hard to determine $$ of health benefits Probable that single use of 6- axis EF is cost- effeceve (cost vs. health benefits)

19 ACKNOWLEDGMENTS Special thanks to Mrs Myriam Denault for the financial analysis of the data

20 REFERENCES 1. Y, E. and F. M, Deformity Correc5on with an external Fixator: ease of use and accuracy? Orthopedics, (2). 2. Blondel, B., et al., Limb lengthening and deformity correc5on in children using hexapodal external fixa5on: preliminary results for 36 cases. Orthop Traumatol Surg Res, (6): p Sluga, M., et al., Lower limb deformi5es in children: two- stage correc5on using the Taylor spa5al frame. J Pediatr Orthop B, (2): p Fadel, M. and G. Hosny, The Taylor spa5al frame for deformity correc5on in the lower limbs. Int Orthop, (2): p Dammerer, D., et al., Clinical value of the Taylor Spa5al Frame: a comparison with the Ilizarov and Orthofix fixators. J Child Orthop, : p Rozbruch, S.R., et al., Does the Taylor Spa5al Frame accurately correct 5bial deformi5es? Clin Orthop Relat Res, (5): p Kris5ansen, L.P., H. Steen, and O. Reikeras, No difference in 5bial lengthening index by use of Taylor spa5al frame or Ilizarov external fixator. Acta Orthop, (5): p Manner, H.M., et al., Accuracy of complex lower- limb deformity correc5on with external fixa5on: a comparison of the Taylor Spa5al Frame with the Ilizarov Ringfixator. J Child Orthop, : p Bleichrodt H, Quiggin J (December 1999). "Life- cycle preferences over consump5on and health: when is cost- effec5veness analysis equivalent to cost- benefit analysis?". J Health Econ 18 (6): Black, William (1990). "A Graphical Representa5on of Cost- Effec5veness.". Med Decis Making 10 (3):

21 Thank you

22 STATISTICS IBM SPSS sta5s5cs version for mac Means and standard devia5ons Sta5s5cal significance p 0,05 Student t- test for normally distributed Mann Whitney U Test for non- normally Frequency difference in primary diagnosis Pearson chi- squared test.

23 UNEVEN DIAGNOSIS DISTRIBUTION Ilizarov 6- Axis EF Dysplas5c Congenital Trauma5c Developmental Pathologic Dysplas5c Congenital Trauma5c Developmental Pathologic