Abstract
The purpose of the present study was to determine whether surgical intervention with
open reduction internal fixation (ORIF) or primary arthrodesis (PA) for Lisfranc injuries
is more cost effective. We conducted a formal cost-effectiveness analysis using a
Markov model and decision tree to explore the healthcare costs and health outcomes
associated with a scenario of ORIF versus PA for 45 years postoperatively. The outcomes
assessed included long-term costs, quality-adjusted life-years (QALYs), and incremental
cost per QALY gained. The costs were evaluated from the healthcare system perspective
and are expressed in U.S. dollars at a 2017 price base. ORIF was always associated
with greater costs compared with PA and was less effective in the long term. When
calculating the cost required to gain 1 additional QALY, the PA group cost $1429/QALY
and the ORIF group cost $3958/QALY. The group undergoing PA overall spent, on average,
$43,192 less than the ORIF group, and PA was overall a more effective technique. Strong
dominance compared with ORIF was demonstrated in multiple scenarios, and the model's
conclusions were unchanged in the sensitivity analysis even after varying the key
assumptions. ORIF failed to show functional or financial benefits. In conclusion,
from a healthcare system's standpoint, PA would clearly be the preferred treatment
strategy for predominantly ligamentous Lisfranc injuries and dislocations.
Level of Clinical Evidence
Keywords
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Article info
Publication history
Published online: December 20, 2017
Footnotes
Financial Disclosure: The present study was funded by the American College of Foot and Ankle Surgeons (to R.H.A., S.H., E.K., L.W. Jr., L.W. Sr., and A.E.F.). The content is solely the responsibility of the authors and does not represent the official views of the ACFAS.
Conflict of Interest: None reported.
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© 2017 by the American College of Foot and Ankle Surgeons. All rights reserved.
