Health and cost consequences of surgical versus conservative treatment for a comminuted proximal humeral fracture in elderly patients

Abstract 

Objective

This study aims to evaluate the costs and health outcome for surgical and conservative treatment of displaced proximal humeral fractures.

Design

This study is a randomised controlled trial.

Participants

This study included 50 patients aged 60 or older admitted to hospital with a severely displaced three- or four-part fracture.

Interventions

The patients were treated surgically with an angular stable interlocking implant (25 patients) or conservative treatment (25 patients).

Main outcome measure

The outcomes measured included quality-adjusted life years (QALYs) and societal costs.

Results

At 12 months’ follow-up, the mean difference in the number of QALYs was 0.027 (95% confidence interval (CI)=−0.025, 0.078) while the mean difference in total health-care costs was €597 in favour of surgery (95% CI=−5291, 3777).

Conclusion

There was no significant difference in QALYs or costs between surgical and conservative treatment of severe displaced proximal humeral fractures.

Keywords: Fracture of proximal humerus, Surgical treatment, Conservative treatment, Health related quality of life, 15D score, Economic evaluation