Surgery is a cost-effective option in treating upper arm fractures

Upper arm fractures are common especially in adults of working age. The injury can lead to prolonged absence from work causing significant costs both for the individual and for society. 

“Previous studies have found that surgery and bracing produce a similar functional outcome on average, but there has not been sufficient information on the cost-effectiveness of these treatment methods,” says HUS’ resident Cyrill Suter, who is one of the lead authors of the study article. 

The newly published economic evaluation is based on a Finnish randomized study named FISH (Finnish Shaft of the Humerus) conducted at two university hospitals. The study article was published in The Journal of Bone & Joint Surgery. The study included 82 adult patients at HUS Helsinki University Hospital and Tampere University Hospital. The patients had suffered an upper arm fracture and were randomly assigned either to surgery or functional bracing and then followed for two years. 

Surgery is cheaper from society’s point of view

“We looked at total cost-effectiveness from both societal and health care perspective. In the societal analysis, we also took into account the losses due to work absences. In that perspective, surgical treatment proved to be both more effective and less costly overall,” says researcher and specialist Thomas Ibounig. 

The average total cost per patient was EUR 23,680 in the surgery group and EUR 30,389 in the bracing group. Health benefits were measured in quality-adjusted life years (QALY). The QALYs gained were slightly higher in the surgery group after two-year follow-up.

Decision-making must consider patient’s life situation and broader societal impacts of treatment

When the analysis was narrowed down to just direct healthcare costs, the situation changed: functional bracing was less expensive and therefore more cost-effective. 

According to the researchers, the results highlight the importance of perspective when evaluating various treatment methods. 

“If we take into account the restoration of work ability and the economic impacts of that, surgery is a justified option, particularly for working-age patients,” says Suter. 

Functional bracing is still a viable and economically sound solution for patients whose absence from work does not cause significant costs and whose individual factors support conservative treatment.

Head Physician Lasse Rämö from HUS Orthopedics and Traumatology considers the study significant: “The results support shared decision-making, in which both the patient's life situation and the broader societal impacts of treatment are taken into account.”

Link to the research article: Cost-Effectiveness of Surgery Versus Functional Bracing for Humeral Shaft Fractures in Adults

Further information:

Cyrill Suter, MD, resident in orthopedics and traumatology, cyrill.suter@hus.fi

Thomas Ibounig, MD, specialist in orthopedics and traumatology, thomas.ibounig@hus.fi

Lasse Rämö, MD, PhD, specialist in orthopedics and traumatology, Head of Musculoskeletal Surgery, lasse.ramo@hus.fi