TheUseOf6Axis External$Fixaon$ …llrs.org/PDFs/Annual Meeting Presentations...ILIZAROV$ •...
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The Use Of 6Axis External Fixa5on Is More CostEffec5ve Than Ilizarov For Canadian Health Care Centres Khalid Alkhelaifi MD, Elisabeth Leblanc, MSc MD FRCSC Mohammad Alzahrani MD; Karine Perreault MSc, Marie Gdalevitch MD FRCSC
Transcript of TheUseOf6Axis External$Fixaon$ …llrs.org/PDFs/Annual Meeting Presentations...ILIZAROV$ •...
The Use Of 6-‐Axis External Fixa5on Is More Cost-‐Effec5ve Than Ilizarov For Canadian Health Care Centres
Khalid Alkhelaifi MD, Elisabeth Leblanc, MSc MD FRCSC
Mohammad Alzahrani MD; Karine Perreault MSc, Marie Gdalevitch MD FRCSC
DISCLOSURES
• Senior author is an educa5onal consultant for Smith and Nephew
Post-Traumatic
Dysplastic
Congenital
Deformity correction Limb lengthening
Developmental
Pathologic
INTRODUCTION
And Or
CIRCULAR EXTERNAL FIXATION
6-Axis EF (TSF) Ilizarov
ILIZAROV
• Important innova5on in limb reconstruc5on
• Rings, threaded rods and hinges
• Difficulty in mul5-‐planar and rota5onal correc5ons
• Increase need to return to OR for adjustments
TAYLOR SPATIAL FRAME
• Computer assisted 6-‐axis deformity correc5on EF
• Mul5-‐planar and rota5onal deformity correc5on
• More accurate correc5ons
• Decreases return to OR
ILIZAROV RING FIXATOR
• Difficulty with multi-planar corrections
• Increase need to return to OR for frame adjustments
• Gold standard in Canada due to lower cost of equipment
• Mean unit cost : 1600$
TSF (6 axis EF) • Mul6-‐planar correc6ons
• Improved accuracy
• Decreased complica6ons
• Limited use in Canada due to cost
• Standard in US
• Mean unit cost: 8000$
ILIZAROV VS. TSF
• Publicly-‐funded • Elevated implant costs = limit their poten5al use • Difficult to get hospitals to approve budgets for 6 axis EF
secondary to its cost
CANADIAN HEALTH CARE SYSTEM
Determine if the use of the TSF (or 6-‐axis EF) is cost-‐effecEve given the iniEal implant cost?
OBJECTIVE
GAIN IN HEALTH
COST ASSOCIATED
COST-‐EFFECTIVENESS Is an economic evalua5on that determines both the cost and health outcomes of alterna5ve interven5on strategies: Ilizarov vs. TSF
Choose the most cost-‐effec5ve fixator from the perspec5ve of a Hospital in the Canadian
Health Care System
Included Excluded • Initial admission and OR time • Implants • Readmission • Reoperation (for complications or
readjustments)
• Surgeon / anesthetist fees (not paid by hospital)
• Complications not requiring OR
Deformity and LLD
cases from 2006-2013:
70 cases 11 excluded (clubfeet)
59 included
29 Ilizarov
30 TSF
METHODS
Total treatment cost per paEent
Shriners Hospital Montreal
Cost differenEal (TSF – Ilizarov)
Health benefits (TSF – Ilizarov)
IniEal procedure
Implant
Admission
Opera5ng room
Added procedures
Re-‐Admission
Return to OR
TOTAL TREATMENT
Favorable to TSF
Unfavorable to TSF
Neutral
Per patient
RESULTS
Cost differenEal (TSF – Ilizarov)
Health benefits (TSF – Ilizarov)
IniEal procedure
Implant + $6,400 Increased accuracy
Admission
Opera5ng room
Added procedures
Re-‐Admission
Return to OR
TOTAL TREATMENT
Favorable to TSF
Unfavorable to TSF
Neutral
Per patient
RESULTS
Cost differenEal (TSF – Ilizarov)
Health benefits (TSF – Ilizarov)
IniEal procedure
Implant + $6,400 Increased accuracy
Admission No difference No difference
Opera5ng room No difference No difference
Added procedures
Re-‐Admission
Return to OR
TOTAL TREATMENT
Favorable to TSF
Unfavorable to TSF
Neutral
Per patient
RESULTS
Cost differenEal (TSF – Ilizarov)
Health benefits (TSF – Ilizarov)
IniEal procedure
Implant + $6,400 Increased accuracy
Admission No difference No difference
Opera5ng room No difference No difference
Added procedures
Re-‐Admission -‐ $566,08 -‐ 1,4 days saved per pa5ent
Return to OR
TOTAL TREATMENT
Favorable to TSF
Unfavorable to TSF
Neutral
Per patient
RESULTS
TSF Ilizarov
CAD
Cost of readmission
Cost differenEal (TSF – Ilizarov)
Health benefits (TSF – Ilizarov)
IniEal procedure
Implant + $6,400 Increased accuracy
Admission No difference No difference
Opera5ng room No difference No difference
Added procedures
Re-‐Admission -‐ $566,08 -‐ 1,4 days saved per pa5ent
Return to OR -‐ $581,29 -‐ 1.5 hrs saved per pa5ent
TOTAL TREATMENT
Favorable to TSF
Unfavorable to TSF
Neutral
Per patient
RESULTS Cost OR returns
TSF Ilizarov
CAD
Favorable to TSF
Unfavorable to TSF
Neutral
Per patient
RESULTS Cost differenEal (TSF – Ilizarov)
Health benefits (TSF – Ilizarov)
IniEal procedure
Implant + $6,400 Increased accuracy
Admission No difference No difference
Opera5ng room No difference No difference
Added procedures
Re-‐Admission -‐ $566 -‐ 1,4 days saved per pa5ent
Return to OR -‐ $581 -‐ 1.5 hrs saved per pa5ent
TOTAL TREATMENT + $3,763 (single use)
No difference (used twice)
Total cost and implant re-‐use
Implant reuse
Total cost (CA
D)
TSF
Ilizarov
Favorable to TSF
Unfavorable to TSF
Neutral
Per patient
RESULTS Cost differenEal (TSF – Ilizarov)
Health benefits (TSF – Ilizarov)
IniEal procedure
Implant + $6,400 é accuracy
Admission No difference No difference
Opera5ng room No difference No difference
Added procedures
Re-‐Admission -‐ $566 -‐ 1,4 days
Return to OR -‐ $581 -‐ 1.5 hrs
TOTAL TREATMENT + $3,763 (single use)
ê complica5ons No difference (used twice)
Complica5on rate
TSF Ilizarov
Num
ber o
f com
plica5
ons
CONCLUSION • Re-‐admission, return to OR and complica5on rates were all significantly lower in the TSF
• TSF Cost-‐effec5ve? = YES! • Clear added health benefits with no significant difference in cost if implants are used twice – In Canada re-‐use frames
For Canadian Hospitals 6-‐axis EF is a cost-‐effecEve soluEon for limb reconstrucEon
DISCUSSION
• Is 6-‐axis EF cost-‐effec5ve for single use? • Single use is $3 763 more expensive but… Does not account for: • Surgeon and anaesthe5st fees for each OR return • Opportunity cost of the OR • Socio-‐economic cost to the pa5ent • Hard to determine $$ of health benefits
Probable that single use of 6-‐axis EF is cost-‐effecEve (cost vs. health benefits)
ACKNOWLEDGMENTS
Special thanks to Mrs Myriam Denault for the financial analysis of the data
REFERENCES 1. Y, E. and F. M, Deformity Correc5on with an external Fixator: ease of use and accuracy? Orthopedics, 2009. 32(2). 2. Blondel, B., et al., Limb lengthening and deformity correc5on in children using hexapodal external fixa5on: preliminary results for 36 cases. Orthop Traumatol Surg Res, 2009. 95(6): p. 425-‐30. 3. Sluga, M., et al., Lower limb deformi5es in children: two-‐stage correc5on using the Taylor spa5al frame. J Pediatr Orthop B, 2003. 12(2): p. 123-‐8. 4. Fadel, M. and G. Hosny, The Taylor spa5al frame for deformity correc5on in the lower limbs. Int Orthop, 2005. 29(2): p. 125-‐9. 5. Dammerer, D., et al., Clinical value of the Taylor Spa5al Frame: a comparison with the Ilizarov and Orthofix fixators. J Child Orthop, 2011. 5: p. 343-‐9. 6. Rozbruch, S.R., et al., Does the Taylor Spa5al Frame accurately correct 5bial deformi5es? Clin Orthop Relat Res, 2010. 468(5): p. 1352-‐61. 7. Kris5ansen, L.P., H. Steen, and O. Reikeras, No difference in 5bial lengthening index by use of Taylor spa5al frame or Ilizarov external fixator. Acta Orthop, 2006. 77(5): p. 772-‐7. 8. Manner, H.M., et al., Accuracy of complex lower-‐limb deformity correc5on with external fixa5on: a comparison of the Taylor Spa5al Frame with the Ilizarov Ringfixator. J Child Orthop, 2007. 1: p. 55-‐61. 9. Bleichrodt H, Quiggin J (December 1999). "Life-‐cycle preferences over consump5on and health: when is cost-‐effec5veness analysis equivalent to cost-‐benefit analysis?". J Health Econ 18 (6): 681–708. 10. Black, William (1990). "A Graphical Representa5on of Cost-‐Effec5veness.". Med Decis Making 10 (3): 212–214.
Thank you
STATISTICS
• IBM SPSS sta5s5cs version 21.0.0.0 for mac • Means and standard devia5ons • Sta5s5cal significance p ≤ 0,05 • Student t-‐test for normally distributed • Mann Whitney U Test for non-‐normally • Frequency difference in primary diagnosis Pearson chi-‐squared test.
UNEVEN DIAGNOSIS DISTRIBUTION
Ilizarov
Dysplas5c
Congenital
Trauma5c
Developmental
Pathologic
6-‐Axis EF
Dysplas5c
Congenital
Trauma5c
Developmental
Pathologic
