OBJECTIVES: Delayed healing of a tibial fracture is likely to cause substantial impairment to the patient's quality of life, as well as increasing the risk of complications. This study estimates the total costs of using Exogen, an ultrasound device designed to expedite the healing process, in addition to current practice.METHODS: An economic model was designed in order to estimate the costs and outcomes of each treatment. The model compared Exogen against conservative treatment (i.e. plaster cast), and also considered the cost impact of using Exogen to augment patients who underwent surgery.Resource use for each stage in the pathway was multiplied by the unit cost of that resource. Effectiveness data were drawn from published sources. Cost data were derived from existing national databases, whilst resource use data were based on interviews with clinical experts. The perspective is that of the National Health Service (NHS).RESULTS: Exogen is expected to be cost saving for patients with a fresh tibial fracture who are at risk of delayed healing or non-union. For a current smoker, for example, whose probability of healing is around 63% of the general population, the addition of Exogen reduces expected cost by £1300-£1600 per patient. CONCLUSION: Between 8% and 9% more patients are likely to be healed with Exogen after one year of treatment. For patients with a non-union (defined as a fracture which remains unhealed at 6 months), using Exogen before surgery (where possible and clinically appropriate) is considered is expected to be a lower cost option than immediate surgery. This approach is expected to reduce cost by almost £3,500 per patient, with no significant reduction in fracture healing.The funding for this study was provided by Smith & Nephew.