Purpose: Treatment for acceptably angulated distal radius fractures in children commonly involves cast management. Commercially available wrist splints may offer a safe and less costly alternative to casting, with comparable immobilization and symptom relief. The present study assesses the cost-effectiveness of wrist splints compared to routine casting in children with acceptably angulated distal radius greenstick or transverse fractures.
Methods: A cost-effectiveness analysis was conducted alongside a randomised controlled trial (RCT) at a Canadian urban tertiary pediatric centre. One hundred children with acceptably angulated distal radius greenstick or transverse fractures were randomized to receive a wrist splint or cast. Information on health care provider, patient and family resource use as well as productivity cost was collected over 6 weeks. Resource use was costed using unit costs from local administrative data sources and expense diaries. Effectiveness was assessed at 6 weeks using the Activities Scale for Kids (ASKp) questionnaire. Cost-effectiveness analysis related differential costs to differential ASKp scores.
Results: At 6 weeks, patients managed with splints demonstrated a higher mean ASKp score compared to those managed with casts (92.8 versus 91.4, standard error [SE] 1.585). Mean total cost was $877.58 in the splint group and $950.35 in the cast group, with a mean difference of $-72.76 (SE 45.88). Mean total health care provider cost was $670.66 in the splint group and $768.22 in the cast group (mean difference $-97.56; SE 9.24). Therefore, splint management was more effective and less costly. The reduction in cost was mainly due to the cost of replacing the cast as part of routine assessment at week 1 and the lower acquisition cost of a splint versus a cast. The probability of splints being cost-effective compared to cast management was 94% for a threshold value of $0 for a one unit gain in ASKp score and exceeded 82% for all threshold values.
Conclusions: To our knowledge, this is the first study to compare the cost-effectiveness of casting versus splinting in children with acceptably angulated distal radius greenstick or transverse fracture. Based on resource use and effectiveness data collected in this RCT, splint management was cost-effective compared to conventional casting.
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