Costs and health-related quality of life of non-operative and surgical treatment modalities for displaced distal radius fractures: a comprehensive overview based on the CAST study

PURPOSE: The aim of this study was to provide a comprehensive overview of costs and health-related quality of life (HRQoL) associated with three treatment modalities for common displaced distal radius fractures (DRFs): (1) non-operative treatment, (2) direct plate fixation and (3) delayed plate fixation in case of fracture redisplacement during follow-up. METHODS: A cost and HRQoL analysis was performed based on data collected during the CAST study, a multicenter cluster-randomized controlled trial including adult patients with a displaced DRF, randomized between immobilization with a plaster splint or circumferential cast. Included patients were prospectively followed for one year. Operatively treated patients also continued questionnaire follow-up. From a societal perspective, healthcare costs, patient and family costs, and indirect (i.e. productivity) costs were collected. Patients completed questionnaires on HRQoL (EQ-5D-5 L), healthcare consumption and work productivity. RESULTS: In total, 693 patients were included in this study (non-operative: 402, direct plate fixation: 165, delayed plate fixation: 126). The estimated mean total costs per patient were €2,212 for non-operative treatment, €4,339 for direct plate fixation and €4,393 for delayed plate fixation HRQoL improved between 3 and 12 months but did not reach pre-injury HRQoL in all groups. CONCLUSIONS: This study provides a descriptive overview of societal costs of displaced DRF treatment. Non-operative treatment is least costly. The cost differences between direct and delayed plate fixation is €58 in favor of direct plate fixation. Starting with non-operative treatment and later deciding whether to proceed with operative treatment based on alignment changes during follow-up, could reasonably be considered as a treatment option. HRQoL improved in all groups.