An Economic Evaluation of Operative Compared with Nonoperative Management of Displaced Intra-Articular Calcaneal Fractures
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Bibliographic record
Abstract
BACKGROUND: The choice of therapy for a displaced intra-articular calcaneal fracture has long been a source of uncertainty in orthopaedic surgery, both in terms of the impact of the therapy on clinical outcomes and on health-care and non-health-care costs. We performed an economic evaluation, based on the results of a randomized clinical trial, to evaluate the economic implications of operative compared with nonoperative management of this fracture. METHODS: An economic evaluation was performed, with use of a four-year time horizon, to determine the effect on costs and health benefits of operative compared with nonoperative management for a group of patients with displaced intra-articular fractures of the calcaneus. The complication rate, arthrodesis rate, survival data, and health-outcome data were estimated prospectively from a recent randomized clinical trial. Direct health-care costs and indirect costs (the cost of time lost from work) were estimated retrospectively from the center treating the majority of the patients. RESULTS: Operative management resulted in a lower rate of subtalar arthrodesis and a shorter time off from work compared with nonoperative treatment. When indirect costs, such as the time lost from work, were included in the analysis, operative management was less costly (an average savings of Can$19,000 per patient) and more effective, thus making it the preferred strategy. The result was most sensitive to the estimates of the costs of time lost from work. When these costs were excluded, operative treatment remained more effective, but with an increased average cost of Can$2800 per patient. CONCLUSIONS: Calcaneal fractures have been recognized as having relatively poor clinical outcomes and a major socioeconomic impact with regard to time lost from work and recreation. Our analysis suggests that operative management of displaced intra-articular fractures is economically attractive. However, further exploration of the impact and valuation of time lost from work and patient outcomes is required.
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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 | 0.002 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| 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 it