Proefschrift

Chapter 8 116 surgically treated trauma patients with peri- and/or intra-articular fractures of the lower extremities. Overall PWB is accompanied by less costs over a period of 26-weeks post-surgery. The total costs per patient, consisting of patient-family expenses, healthcare costs and productivity loss, were €457.51 less in the PWB group. Based on the LEFS, PWB seems considerably more effective, as was shown in the base case and in all if the sensitivity analyses. Despite the outcomes of the economic evaluation, there were no significant differences in QALY outcomes, the PWB seems not to achieve much improvement in QALY during the 26 weeks follow-up period. No improvement in QALY’s in trauma patients with per-and intra-articular fractures might be the short period of disability and therefore may have lesser impact on the quality of life of a patient.38 In het Netherlands, annually, the incidence of peri- and/or intra-articular fractures of the lower extremities is more than 25,000 patients.1 This study found that the PWB protocol is €457.51 cheaper compared to the usual current RWB protocol. Annually, this may result in a saving of at least €11,437,750 in the Netherlands. Our study, the first largest prospective multicenter cohort study comparing PWB with RWB, adds evidence in support of the use of PWB in surgically treated trauma patients with peri- and/or intra-articular fractures of the lower extremities. This study shows that PWB is cost-effective compared to the RWB protocol. To our knowledge, little is known about the cost or cost-effectiveness in trauma patients with peri- and/or intra-articular fractures of the lower extremities, also due to the fact that the PWB protocol is a relatively new protocol. However, studies about early weight bearing have been contesting the current guidelines. 3,5-12 Due to the structure of the data collection there was almost no missing data, resulting in no exclusion due to missing data. When interpreting our data, some limitations have to be considered. The non-randomized nature of the study limits the data quality. On the other hand, patients were allocated to the PWB and RWB surgical teams consecutively to avoid selection bias. There were discrepancies regarding the patients’ comorbidities and the different hospitals in which the patients were treated. Our statistical analyses took these discrepancies into consideration, thus correcting the presented results for the confounding influence that these factors may have had on the study results. Another limitation was the lower utility scores of the SF-12 versus the ones of the EQ-5D. The question which of the two measured the utility score more accurately was raised for this assessment. It is argued that the EQ-5D has a more general approach, while SF-12 may be better suited to capture certain facets of health status40 and therefore may be more sensitive to this population. A combination of the SF-12 and the EQ-5D may provide a relatively broad coverage of important health

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