Is Surgical Fixation for Stress-Positive Unstable Ankle Fractures Cost Effective? Results of a Multicenter Randomized Control Trial
Bibliographic record
Abstract
OBJECTIVES: A recent multicenter randomized control trial demonstrated similar quality of life at 1 year after open reduction and internal fixation (ORIF) compared with nonoperative treatment for stress-positive unstable isolated lateral malleolar fractures. We sought to determine the cost-effectiveness of ORIF compared with nonoperative management of these isolated lateral malleolar fractures. DESIGN: Cost-utility analysis using decision tree and Markov modeling based on data from a prospective randomized control trial and previously published literature. A single-payer perspective with 1-year and lifetime time horizons was adopted. SETTING: Clinical trial data from 6 Canadian level I trauma hospitals. INTERVENTION: Lateral malleolus ORIF versus nonoperative treatment. MAIN OUTCOME MEASUREMENTS: Incremental cost-effectiveness ratio (ICER). RESULTS: The base case 1-year ICER of the ORIF treatment was $205,090 per quality-adjusted life year gained, favoring nonoperative treatment. For the lifetime time horizon, ORIF becomes the preferred treatment with an ICER of $16,404 per quality-adjusted life year gained. This conclusion is stable provided ORIF lowers the lifetime incidence of ankle arthrosis by >3% compared with nonoperative treatment. Probabilistic sensitivity analysis demonstrated that 33% of model simulations favored ORIF in the 1-year time horizon and 65% of simulations in the lifetime time horizon. CONCLUSIONS: From a single-payer governmental perspective, ORIF does not seem to be cost effective in the 1-year time horizon; however, if operative fixation decreases the lifetime incidence of posttraumatic ankle arthrosis by >3%, then ORIF becomes the economically preferred treatment. LEVEL OF EVIDENCE: Economic Level II. See Instructions for Authors for a complete description of levels of evidence.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".