OBJECTIVES : After the inception of the AO Foundation in1958, fracture osteosynthesis (OS) was introduced in Switzerland and in the following 2 to 3 decades globally. OS has revolutionized fracture care. However, there has never been a formal impact evaluation of OS as a medical innovation. It was the aim to estimate the health economic impact of OS in fracture care for three index bones over 60 years in 17 high-income countries.

METHODS : A modelling approach using a decision tree was applied for this cost comparison study. To do so, a (hypothetical) absence of the OS technology was presumed and OS (intervention) was compared with conservative treatment (CONS; comparator) from a societal perspective. We included fracture patients with femur, tibia and radius fractures (age <65yr.); for proximal femur fractures elderly patients (≥70yr.) were also included. Outcomes were differences between OS and CONS in years of life gained (YLG), direct and indirect costs (2015 Swiss Francs for all modelled years; discount rate 3%). We used data from the Swiss Accident Insurance, OECD and World Bank. From our base case Switzerland, we extrapolated our results to 16 other high-income countries from four continents (Europe, North America, Asia, Australia) and performed sensitivity analyses.

RESULTS : In the working age population, CHF 855 bn. (sensitivity analysis: min. CHF 360 bn. to max. CHF 1213 bn.) were saved in direct and indirect costs over 6 decades in 17 countries for femur, tibia and radius fractures. 4.6 million YLG were gained in this age group (2/3 of them before age 65 and included in indirect costs). In the elderly population with proximal femur fractures, CHF 69 bn. were saved in direct costs in addition to 73 million YLG.

CONCLUSIONS

: The health economic impact of OS was substantial over six decades. It resulted important productivity gains and YLG.