The importance of costing perspective: an example evaluating the cost-effectiveness of a locking versus nonlocking plate in medial opening wedge high tibial osteotomy

The importance of costing perspective: an example evaluating the cost-effectiveness of a locking versus nonlocking plate in medial opening wedge high tibial osteotomy

Can J Surg 2019;62(1):E14-E16 | PDF | Appendix

Codie A. Primeau, MSc, PhD; Jacquelyn D. Marsh, PhD; Trevor B. Birmingham, PhD; J. Robert Giffin, MD, MBA

Summary

High tibial osteotomy (HTO) fixation can be achieved using various plate designs. Compared with nonlocking plates, the stability of locking plates allows patients to return to weight-bearing and work sooner and may also decrease postoperative complications, introducing the potential for overall cost savings. However, material costs for locking plates are higher, and the plate bulkiness may lead to additional surgery to remove the plate. We conducted a retrospective study to evaluate the cost-effectiveness of a locking versus a nonlocking plate in HTO from both the health care payer and societal perspectives up to 12 months postoperative. We observed that from a health care payer perspective, the locking plate was not cost-effective. However, the locking plate was cost-effective from the societal perspective (addition of indirect costs, such as time off work). These findings highlight the importance of considering costing perspective in economic evaluations for chronic conditions, particularly in publicly funded health care systems.


Accepted July 27, 2018

Affiliations: From the Faculty of Health Sciences, Western University, London, Ont. (Primeau, Marsh, Birmingham); the School of Kinesiology, Western University, London, Ont. (Primeau); the School of Physical Therapy, Western University, London, Ont. (Marsh, Birmingham); the Schulich School of Medicine & Dentistry, Western University, London, Ont. (Giffin); the Wolf Orthopaedic Biomechanics Laboratory, Western University, London, Ont. (Primeau, Birmingham, Giffin); the Fowler Kennedy Sport Medicine Clinic, London, Ont. (Primeau, Birmingham, Giffin); and the Bone and Joint Institute, Western University, London, Ont. (Primeau, Marsh, Birmingham, Giffin).

Competing interests: None declared.

Contributors: All authors contributed substantially to the conception, writing and revision of this article and approved the final version for publication.

DOI: 10.1503/cjs.018317

Correspondence to: C. Primeau, School of Health and Rehabilitation Sciences, Western University, Rm 1400, London ON N6G 1H1, cprimea@uwo.ca