Trial reportPloS one2026
Cost-effectiveness of cast treatment vs. surgery in elderly patients with substantially displaced intra-articular distal radius fractures: A trial-based economic evaluation.
Trial report in PloS one, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
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Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
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Authors and funding
9 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe number of surgical procedures for distal radius fractures in the elderly has increased, even though most studies show little or no benefit over cast treatment. While medical costs of surgical treatment are higher than those of cast treatment, surgery may enable faster recovery and help patients maintain independence, potentially reducing their use of other healthcare resources and informal care.
methodsWe evaluated whether cast treatment is cost-effective compared to surgery for patients aged 65 years or older with substantially displaced intra-articular distal radius fractures. A multicentre randomized controlled non-inferiority trial with an economic evaluation in 19 hospitals in the Netherlands. Participants completed (cost) questionnaires at baseline, 3, 6, 9 and 12 months after trauma. A total of 138 patients were randomized between cast treatment and surgery. Health-related quality of life was measured with the EQ-5D-3L; wrist function was measured with the Patient Rated Wrist Evaluation (PRWE). Costs were assessed from a societal perspective, including intervention costs, healthcare use, informal care, unpaid productivity losses, and patients' own expenses.
resultsThe estimated difference in total societal costs was -€81 (95%CI -€3936 to €3773) in favour of cast treatment compared with surgical treatment. Compared with cast treatment, surgery resulted in improved wrist function (PRWE: -5.5; 95% CI: -10 to -0.7) and slightly higher QALYs (+0.039; 95%CI 0.012 to 0.066), equivalent to 14 days in perfect health. The incremental cost-effectiveness ratio was €15 per point improvement in PRWE and €2070 per QALY gained. Cast treatment's probability of cost-effectiveness was low for all values of willingness to pay.
conclusionAlthough cast treatment had lower direct costs, these were offset by higher informal and secondary care costs. Surgical treatment offered clinically relevant short-term benefits. From a societal perspective, surgery appears to be the more favorable option for elderly patients with displaced distal radius fractures.
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