Early mobilization versus plaster immobilization of simple elbow dislocations: a cost analysis of the FuncSiE multicenter randomized clinical trial

Lieshout, E.M.M. van; Iordens, G.I.T.; Polinder, S.; Eygendaal, D.; Verhofstad, M.H.J.; Schep, N.W.L.; ... ; FuncSiE Trial Investigators (2019)

Article / Letter to editor

Introduction The primary aim was to assess and compare the total costs (direct health care costs and indirect costs due to loss of production) after early mobilization versus plaster immobilization in patients with a simple elbow dislocation. It was hypothesized that early mobilization would not lead to higher direct and indirect costs. Materials and methods This study used data of a multicenter randomized clinical trial (FuncSiE trial). From August 25, 2009 until September 18, 2012, 100 adult patients with a simple elbow dislocation were recruited and randomized to early mobilization (immediate motion exercises; n = 48) or 3 weeks plaster immobilization (n = 52). Patients completed questionnaires on health-related quality of life [EuroQoL-5D (EQ-5D) and Short Form-36 (SF-36 PCS and SF-36 MCS)], health care use, and work absence. Follow-up was 1 year. Primary outcome were the total costs at 1 year. Analysis was by intention to treat. Results There were no significant differences in EQ-5D, SF-36 PCS, and SF-36 MCS between the two groups. Mean total costs per patient were euro3624 in the early mobilization group versus euro7072 in the plaster group (p = 0.094). Shorter work absenteeism in the early mobilization group (10 versus 18 days; p = 0.027) did not lead to significantly lower costs for loss of productivity (euro1719 in the early mobilization group versus euro4589; p = 0.120). Conclusion From a clinical and a socio-economic point of view, early mobilization should be the treatment of choice for a simple elbow dislocation. Plaster immobilization has inferior results at almost double the cost.

• Cost-effectiveness
• Cost utility
• Elbow dislocation
• Function
• Quality of life

• All authors: Lieshout, E.M.M. van; Iordens, G.I.T.; Polinder, S.; Eygendaal, D.; Verhofstad, M.H.J.; Schep, N.W.L.; Hartog, D. den; Breederveld, R.S.; Bronkhorst, M.W.G.A.; Haan, J. de; Vries, M.R. de; Dwars, B.J.; Haverlag, R.; Meylaerts, S.A.G.; Mulder, J.W.R.; Patka, P.; Ponsen, K.J.; Roerdink, W.H.; Roukema, G.R.; Schipper, I.B.; Schouten, M.A.; Sintenie, J.B.; Sivro, S.; Tuinebreijer, W.E.; Brand, J.G.H. van den; Linden, F.M. van der; Meulen, H.G.W.M. van der; Verleisdonk, E.J.M.M.; Vroemen, J.P.A.M.; Waleboer, M.; Willems, W.J.; FuncSiE Trial Investigators
• Date: 2019-11-23
• Journal: Archives of Orthopaedic and Trauma Surgery
• DOI: doi:10.1007/s00402-019-03309-1