Chapter 8 102 Abstract Introduction The actual guidelines concerning the aftercare of surgically treated trauma patients with peri- and/or intra-articular fractures of the lower extremities advocate restricted weight bearing (RWB). The aim of this study was to compare the cost-effectiveness and the cost-utility of a new permissive weight bearing (PWB) protocol with the standard RWB protocol from both a societal and a hospital perspective. Materials and methods This prospective comparative cohort study included surgically treated trauma patients with peri- and/or intra-articular fractures of the lower extremities followed by PWB or RWB. Costs, Activities of Daily Living (ADL) and quality of life were measured during 26 weeks (at baseline, 2, 6, 12 and 26 weeks post-surgery). Cost per quality adjusted life year (QALY) gained (cost-utility) and cost per ADL or Life Years (cost-effectiveness) were estimated. Bootstrapping and sensitivity analyses were conducted to characterize uncertainty. Results This study included 106 trauma patients (N=53 in both the PWB and the RWB-group). There were no significant group differences in baseline characteristics. Costs were lowest for the PWB group (€9,379.45 vs €9,836.96) during 26 weeks post-surgery. Conclusions PWB is more cost-effective compared to the RWB regimen. Moreover, the PWB-group showed more improvement in ADL compared to the RWB-group.