ArticleBMJ global health2026
Cost-effectiveness of surgical and conservative interventions for orthopaedic injuries in Malawi: a modelling study.
Article in BMJ global health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundOrthopaedic injuries are a major contributor to morbidity and mortality in low-income settings, driven by rising urbanisation and inadequate road safety measures. This study evaluates the cost-effectiveness of treatment for four common orthopaedic injuries in Malawi: femoral shaft fractures, patellar fractures, humeral shaft fractures and paediatric supracondylar humeral fractures (PSCHF).
methodsWe developed a dynamic state-transition model to simulate fatal and non-fatal outcomes from a healthcare perspective from 2021 to 2031, informed by cost, epidemiological and population estimates. We estimated incremental cost-effectiveness ratios (ICER) for conservative and surgical management versus no treatment and each other, conducting one-way and probabilistic sensitivity analyses. We then modelled the population impact of scaling up the most cost-effective intervention under two scenarios.
findingsFor femoral shaft fractures, surgical, conservative and no treatment resulted in disability-adjusted life years (DALYs) of 0.10, 0.21 and 0.23, with ICERs of approximately US$3000 and US$60 000 for surgical and conservative treatment. For patellar fractures, DALYs were 0.20, 0.22 and 0.32, with similar cost-effectiveness (ICERs of US$1400). For humeral shaft fractures, DALYs were 0.041, 0.056 and 0.11, with ICERs of US$3000 and US$1400. For PSCHF, DALYs were 0.04, 0.086 and 0.14, with ICERs of US$1600 and US$2600. Comparison of surgical and conservative strategies shows surgery was cost-saving for femoral shaft fractures, similar for patellar fractures, less efficient for humeral shaft fractures and more cost-effective for PSCHF. At Malawi's willingness-to-pay threshold of US$65 per DALY averted, the probability of cost-effectiveness was low. Under the ambitious scale-up scenario, approximately 1800 DALYs (a 10% reduction relative to the baseline) were averted at an incremental cost of US$5 million.
conclusionIn Malawi, surgery is more cost-effective for femoral shaft and PSCHF fractures, whereas conservative care is more cost-effective for humeral shaft fractures. For patella fractures with an intact extensor mechanism, both treatments are similarly cost-effective. Targeted scale-up could yield substantial health gains, underscoring the importance of context-specific data for prioritising orthopaedic services in low-resource settings.
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