Proefschrift

Economic burden of the postoperative management in peri- and/or intra-articular fractures of the lower extremities 39 guideline were used.23 These reference prices were multiplied by the average healthcare consumption as measured with the iMCQ and iPCQ. In accordance with the guidelines, all hours of unpaid work were valued as replaced by payed help.23 The costs of medication were based on the price per dosage. Prescription costs were added for all medications except for over-the-counter drugs. A distinction was made between first prescriptions (€12) and repeated prescriptions (€6). Costs were, where necessary, indexed for the year 2018. To check for the potential influence of assumptions made in the analyses, several sensitivity analyses were performed. The choice of the societal perspective was based on Dutch guidelines,21 and other validated perspectives,24 societal costs versus healthcare costs were compared. Furthermore, subgroup analyses were performed. The groups were respectively; employed subjects, unemployed subjects, subjects who endured complications during rehabilitation and subjects who did not endure complications during rehabilitation. The perceived performance in ADL was measured with the Lower Extremity Functional Scale (LEFS). The LEFS consists of 20 questions about a person’s ability to perform daily tasks. Each question can be scored from 0 to 4, where 0 represents extreme difficulty to perform the activity. The maximum possible score is 80 points, corresponding to no disability. The lower the score, the greater the disability.25 The QoL was measured with the EuroQol 5-Level EQ-5D questionnaire. The EuroQol 5-Level EQ5D questionnaire consists of five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Each dimension was scored on a five-point scale ranging between no problems and extreme problems.26 Quality Adjusted Life Years (QALYs) were subsequently calculated by multiplying utilities with 26 weeks, resulting in a QALY estimate of 0.23. The secondary outcome measure was complications after a follow-up of 26 weeks post-surgery. Postoperative complications (e.g. complications related to the fracture and general complications non-related to the fracture) were defined as any adverse event that required intervention within 26 weeks; these were recorded as either present or absent, along with the type of complication. Economic analysis All analyses were performed according to the intention-to-treat principle and therefore included all participants. Clinical differences between the patients with a paid job and patients without a paid job were assessed using a linear mixed-effects regression model in SPSS (IBM SPSS Statistics, Version 25.0, Armonk, New York). Due to the random nature of the patient participation, it was decided that no distinction would be made

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