Cost-effectiveness of 3D-guided corrective osteotomy compared with 2D-planned corrective osteotomy for patients with malunion of the distal radius from a Dutch societal perspective : an early economic evaluation

Background: Malunion is the most common complication of distal radius fractures, leading to wrist pain, functional impairment, and cosmetic deformity. Conventional treatment involves corrective osteotomy using two-dimensional (2D) preoperative planning. However, planning a corrective osteotomy using 2D images can be challenging, making it hard to achieve optimal outcomes. The use of three-dimensional (3D) planning and patient-specific guides shows promising effects on patient outcomes. However, 3D planning leads to additional costs. It is crucial to investigate the cost-effectiveness of 3D planning versus 2D planning to determine if the potential benefits of 3D-guided corrective osteotomy justify the higher expenses. Objective: The aim of this study was to conduct an early cost-effectiveness analysis comparing 3D-guided corrective osteotomy to 2D-planned corrective osteotomy in patients with distal radius malunion, from a Dutch societal perspective. Method: A health state transition model was developed to evaluate the cost-effectiveness of 3D-guided corrective osteotomy versus 2D-planned corrective osteotomy, from a Dutch societal perspective. The outcome of interests were quality-adjusted life-years (QALYs) gained, number of revisions in each strategy, and incremental cost-effectiveness ratio (ICER) per QALY gained. Model inputs, including transition probabilities, costs, and utilities were based on patient data from OCON Orthopaedic clinic in the Netherlands and from published literature. One-way deterministic and probabilistic sensitivity analyses were performed to investigate the impact of parameter uncertainty on the outcomes. Several scenario analyses were performed, including incorporating a hospital perspective and incorporating improved recovery for patients treated with the 3D strategy. Results: 3D-guided corrective osteotomy led to 0.004 incremental QALYs and reduced costs by €72.36, making the intervention cost-effective. At a willingness to pay threshold (WTP) of €20,000 the probability of the 3D approach being cost-effective was 0.77. Scenario analyses showed that from a hospital perspective, the 3D approach is not cost-effective. Furthermore, the analysis incorporating improved recovery for 3D patients resulted in a higher incremental QALY of 0.085. Conclusion: This early cost-effectiveness analysis suggests that 3D-guided corrective osteotomy is expected to be cost-effective compared to 2D-planned corrective osteotomy, from a Dutch societal perspective, indicating that 3D-guided corrective osteotomy should be adopted. However, further research into differences in revision rates and patient recovery between the two strategies is necessary to address uncertainties.