OBJECTIVES:

The current standard acute compartment syndrome (ACS) diagnostic method is often clinical opinion and non-continuous pressure monitoring, which relies on regular checking and patient symptoms that may be compromised by impaired consciousness. This can lead to delayed or incorrect diagnoses, allowing extensive muscle necrosis to develop or unnecessary fasciotomy. The aim of this early study was to determine the potential cost-effectiveness of a new continuous pressure monitoring device in patients treated for a tibial fracture who are at risk of developing ACS.

METHODS:

A decision-tree model was developed from a UK NHS perspective to capture events in the first 60 days after a tibial fracture, when patients are at highest risk of ACS. Depending on the effectiveness of the diagnostic method, patients moved to one of six ACS outcome groups which were characterised by the scale of necrosis and treatment course. The treatment could include resource-intensive and invasive procedures, namely fasciotomy, skin grafts, limb salvage and amputations, which in turn increased the risk of complications including infection, non-union, amputation and death. Average costs, utilities and hospital length of stay were applied to the ACS outcome groups. Parameter inputs were obtained from UK-specific published literature and clinical opinion where possible.

RESULTS:

The base case results indicated that the intervention was cost saving when compared with standard care. There was also an incremental quality-adjusted life year (QALY) gain resulting in a dominant incremental cost-effectiveness ratio (ICER).

CONCLUSIONS:

This early analysis suggests that the continuous pressure monitoring device could be a cost-effective diagnostic option for patients who have tibial fractures and are at risk of developing ACS in the UK NHS, and therefore potentially other healthcare systems. It was estimated that the intervention was associated with higher specificity and sensitivity than current methods, reduced length of hospital stay, resource and cost savings, and improved patient outcomes.