Invited commentary related to: A cost analysis of internal fixation versus nonoperative treatment in adult midshaft clavicle fractures using multiple randomized controlled trials

Healthcare utilization and related cost of midshaft clavicle fracture treatment in Belgium

INTRODUCTION

The debate regarding the economic impact and cost effectiveness of surgical midshaft clavicle fracture treatment is ongoing. Variations exist between healthcare systems in terms of financing, provider payment mechanism and the role of the government in all of this. Therefore, the primary aim of our study was to describe the in-hospital-related healthcare costs associated with midshaft clavicle fracture treatment in Belgium. The secondary aim was to define those clinical variables that drive the costs related to surgically treated clavicle fractures and define strategies that could reduce these costs.

PATIENTS AND METHODS

A total of 345 patients with a midshaft clavicle fracture were included in the study. We selected 17 clinical variables and 5 cost categories were defined. Three multivariate linear models were built to determine which parameters drive the costs.

RESULTS

The median total healthcare cost for non-operatively treated patients was €367 and the median total cost for operatively treated patients was €3296. The length-of-stay was the most important variable that predicted the total cost. The clinical variables Number of fracture fragments, Delayed Stage Surgery, Revision Surgery and Infection most influenced the length-of-stay.

DISCUSSION

In conclusion, the initial healthcare utilization cost of operatively treated midshaft clavicle fractures is larger than that of non-operatively treated fractures. The length-of-stay is the most important parameter that drives the cost and is predominantly influenced by patients' age, fracture complexity and complications requiring a surgical re-intervention.

LEVEL OF EVIDENCE

III.