Análisis de costo efectividad del uso de la placa de compresión dinámica versus clavo intramedular bloqueado para la fractura proximal de humero en adultos en Colombia

Abstract

Proximal humerus fractures correspond to 5% of fractures in older adults. Fixation through the dynamic compression plate is the most common surgical treatment, but it is associated with high complication rates. Intramedullary blocked nails become an attractive treatment alternative; However, its effectiveness is not yet clear. In order to feed the decision-making process in the definition of the best treatment available in Colombia, the economic cost-effectiveness evaluation (ACE) of the use of the blocked intramedullary nail was performed, in comparison with the dynamic compression plates, for surgical management of the proximal humerus fracture, in the Colombian adult population, from the perspective of the third payer. Costs and health outcomes were obtained from secondary sources and interviews with medical technology providers. The measure of effectiveness used was the consolidation of the fracture. The currency used was the Colombian peso. The estimated RCEI was $ 55.43 million Colombian pesos for each point in the percentage of consolidated fractures. The acceptability curve expresses that the intervention of the intramedullary blocked nail is more than 70% likely to be cost-effective, starting at $300 million Colombian pesos. The decision making about the option to choose is not so obvious and, therefore, the alternative to choose may depend on a lower RCEI than the availability to pay, at the time of the decision.