Aims: This economic evaluation alongside the Articular type C pilon Trial Internal Vs External fixation (ACTIVE) trial assessed the cost-effectiveness of circular external fixation versus internal locking plate for treating patients ≥ 16 years old with a type C closed pilon fracture in the UK. Methods: The base-case analysis was undertaken from the NHS and Personal Social Services (PSS) perspective on an intention-to-treat basis. Healthcare resource use and EQ-5D-5L data was collected at baseline, 3, 6, 12, and 24-month post-randomisation. The incremental cost-effectiveness ratio (ICER) was calculated using seemingly unrelated regression model, with the sampling uncertainty handled via non-parametric bootstrapping. Sensitivity analyses were performed to test the robustness of base-case findings. Subgroup analyses were conducted to explore heterogeneity of cost-effectiveness among type C1/C2 pilon fractures and C3 pilon fractures, respectively. Results: In the base-case, circular external fixation incurred £2,745 (95%CI £-2,329, £7,820) more costs and provided 0.012 (95%CI -0.098, 0.122) more quality-adjusted life years (QALYs) per-participant than internal locking plate. The probability of circular external fixation being cost-effective under the UK cost-effectiveness thresholds of £15,000-£30,000 per QALY ranged from 19% to 25%. The findings were robust to sensitivity analyses. The subgroup analysis found that when used for type C3 pilon fractures, circular external fixation appeared to incur lower costs (£-1,418, 95%CI £-6,322, £9,151) and provided marginally more QALYs (0.022, 95%CI -0.124, 0.168). Conclusion: Circular external fixation is unlikely to be cost-effective for adult patients (≥16 years) with a type C closed pilon fracture in the UK compared to internal locking plate.
CORE (COnnecting REpositories)
CORE (COnnecting REpositories)