Cost-utility analysis of surgical fixation with Kirschner wire versus casting after fracture of the distal radius

M. E. Png, S. Petrou, J. Achten, A. Ooms, S. E. Lamb, H. Hedley, J. Dias, M. L. Costa*, Jonathan A. Cook, Melina Dritsaki, Helen Dakin, Jonathan Jones, Andrew Mckee Kevin Smith, Mohamed Hamadto, Steve Gwilym, Tim Chesser, Jaime Candal-Couto, Caroline Hing, David Giddin, Phil JohnstonAamer Ullah, John Williams, Will Eardley, Makaram Srinivasan, Sridharrao Sampalli, Mark Farrar, Chris Roberts, Khitish Mohanty, Iain MacLeod, Praveen Sarda, Amr Elseehy, Nigel Rossiter, David Warwick, Chris Peach, David MacKay, Richard Benson, Adam Watts, Jonathan Young, Feisal Shah, Stephen Lipscombe, Aaron Ng, C. P. Charalambous, Barnaby Sheriden, Kanthan Theivendran, Pulimamidi Sanjay, Rajesh Nanda, Antony Bateman, Michael Butler, Oliver Keast-Butler, Andrew McAndrew, DRAFFT2 trial collaborators

*Corresponding author for this work

Research output: Contribution to journalArticle (journal)peer-review

1 Citation (Scopus)


Aims: The aim of this study was to compare the cost- effectiveness of surgical fixation with Kirschner (K-) wire ersus moulded casting after manipulation of a fracture of the distal radius in an operating theatre setting. Methods: An economic evaluation was conducted based on data collected from the Distal Radius Acute Fracture Fixation Trial 2 (DRAFFT2) multicentre randomized controlled trial in the UK. Resource use was collected at three, six, and 12 months post-randomization using trial case report forms and participant-completed questionnaires. Cost-effectiveness was reported in terms of incremental cost per quality-adjusted life year (QALY) gained from an NHS and personal social services perspective. Sensitivity analyses were conducted to examine the robustness of cost-effectiveness estimates, and decision uncertainty was handled using confidence ellipses and cost-effectiveness acceptability curves. Results: In the base case analysis, surgical fixation with K-wire was more expensive (£29.65 (95% confidence interval (CI) -94.85 to 154.15)) and generated lower QALYs (0.007 (95% CI -0.03 to 0.016)) than moulded casting, but this difference was not statistically significant. The probability of K-wire being cost-effective at a £20,000 per QALY cost-effectiveness threshold was 24%. The cost-effectiveness results remained robust in the sensitivity analyses. Conclusion: The findings suggest that surgical fixation with K-wire is unlikely to be a cost-effective alternative to a moulded cast in adults, following manipulation of a fracture of the distal radius in a theatre setting.

Original languageEnglish
Pages (from-to)1225-1233
Number of pages9
JournalBone and Joint Journal
Volume104 B
Issue number11
Early online date1 Nov 2022
Publication statusPublished - 1 Nov 2022


  • Adult
  • Bone Plates
  • Bone Wires
  • Cost-Benefit Analysis
  • Fracture Fixation, Internal/methods
  • Fracture Fixation/methods
  • Fractures, Bone
  • Humans
  • Radius
  • Radius Fractures/surgery


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