Cost-effectiveness of surgery versus cast immobilization for adults with a bicortical fracture of the scaphoid waist

Aims The aim of the Scaphoid Waist Internal Fixation for Fractures Trial (SWIFFT) was to determine optimal treatment adults with a bicortical undisplaced or minimally displaced fracture waist scaphoid, comparing early surgical fixation initial cast immobilization, immediate being offered patients nonunion. Methods A cost-effectiveness analysis conducted assess relative merits these forms treatment. differences in costs healthcare system and quality-adjusted life years (QALYs) over one-year follow-up trial two arms were estimated using regression analysis. Results Our base case found that randomized had statistically significantly higher mean NHS £1,295 more than immobilization arm (p < 0.001), primarily due cost surgery. They also marginally better quality life, period, 0.0158 QALYs; however, this not significant = 0.379). combined per additional QALY £81,962, well above accepted threshold used UK internationally. probability surgery cost-effective setting only 5.6%. Conclusion Consistent clinical findings SWIFFT, results indicate scaphoid fractures, nonunion, is form treatment, resulting comparable outcomes less system. Cite article: Bone Joint J 2021;103-B(7):1277–1283.