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Analysis of Social Insurance Costs and Impairment in Displaced Wrist Fractures

Study on costs and impairments in wrist fractures of young and elderly patients, comparing direct medical costs, work incapacity, and disabilities.

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Analysis of Social Insurance Costs and Impairment in Displaced Wrist Fractures

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  1. Social Insurance Costs and Impairment in Displaced Wrist Fractures in Young and Elderly PatientsTh. MULIER, P. MILANTS , P. DONCEEL Werchter / Heilig Hart and UZ LeuvenElton John , Rock Werchter 2007

  2. INTRODUCTION

  3. Case 1 Suicide attempt, 33 y nurse: S.I. cost 9000 E ! Total Medical Cost (TMC) : 3166 E Temp Work incapacity (TWC) : 5600 E No disability cost, RTW: 6 months 0 E

  4. Case 2 Construction worker, 44 y: 40% Econ.loss ! Fell while working at podium TMCost: 2700 E, TWC: 3850 E 11% impairment, 11% disability: 3650 E / year x 21 Change of work …

  5. Most common fracture in elderly • Increasing in young adults (“hype”) No studies about costs and impairment!

  6. PURPOSE Analyze the (SI) cost and impairment in patients with a displaced distal radius fracture (DRF) in two different groups: • young economically active • elderly patients

  7. Types of Costs • Direct Medical Cost (DMC) • Medical Cost for After Treatment = Total Medical Cost (TMC) • Temporary Work Incapacity Cost (TWC) • Impairment/Disability Cost (DC) = Overall cost

  8. MATERIAL AND METHODS

  9. MATERIAL (n=485) Group A: Young ec. active - 105 cases with DRF 17 files medicolegal consults Group B: Elderly,non ec. active - 380 cases with DRF

  10. METHODSFile review / Stat.data analysis(+ML,MDB, KULeuven) : 1. Direct/total medical costs(Gr A + B ,485 cases) 2. Work incapacity period :time, grade, cost ( Gr. A,105) 3. Disability for work % and impairment % (OBSI scale) (Gr B, 17 medicolegal cases)

  11. METHOD (N=105) Assessment (group A): - Functional: PRWE 100- p score - Clinical: Grip strength, ROM (30 p) - Radiological: Criteria - Complications: Malunion, CRPS…

  12. Standard treatment protocol Frykman classification 1-8 Dorsal displaced: • Kapandji (1-4): Displaced, non comm. • Ext fixation: Displaced, comminuted • Ext fixation + pin: Displaced, comminuted Volar displaced: • Plating: Smith fractures

  13. Kap Pinning:60% • Ext fixation:21% • Ext fix + pinning:9% • Volar Plating:10%

  14. RESULTS

  15. 1.Direct medical cost 1455 Euro (range 645-18650) • 19 % preoperative costs, 63 % cost for technical acts (surgery, anaesthesia, implant material) ,18 % hospital stay

  16. Direct Medic.Costs / Gender:1258 E (male) versus 1522 E (female) (P<0,04)

  17. Direct Medical Cost • Non Significant : Cost versus age, ASA, functional status residence prior to admission • Significant : Cost versus surgeon, type of treatment, gender

  18. 2. Temporary work incapacity (N=105) • Duration of work incapacity: mean 73 days (range: 1–396) • Cost of temporary work incapacity: 2244 E

  19. 3. Impairment / Disability: 7,4% Kapandji 6 % Plate osteosynthesis 8% External fixation 8% Ext fixation plus pinning 9,4% • Cost: ? (1850-8966 E/year) times 25 (50000E) • Predictive parameters: preop XR, CRPS, DIC

  20. 4. Return to work: 72% : same work, 12 % Half time 12% : changed to another profession 16% : remained on sick leave ! • Higher education: pos. effect on outcome, quicker RTW

  21. DISCUSSION

  22. 1. SI Cost : 4105 Euro Two studies in literature: - Paris study (1999): DMCost 800 E - London study (1968): comp. cost: 85 P Our study: 1960 E / 2244 E / (50000 E) - Reduction of costs ? difficult …

  23. 2.Impairment: 7,3% • No correl.betweenPRWE and impairment % • Should also include radiological criteria, clinical and disab. Measurements • High cost (mean 50000 E)

  24. 3.Duration work incapacity/ RTW 1.Duration: Our series: 11 weeks (73 days) Literature: 5-14 weeks 2 .Return to work: Our series: 84% RTW, 16% permanent WI ! Literature: 72-93% RTW

  25. 4.Which type of treatment ? • Best: Kapandji > Plating> Ext fixation • Biassed …

  26. 5. Limitations in our study • Total cost of DRF ? (salary cost?, total psych impact?, production loss?) • Too small subgroups (in group A) • Difficult to compare with other countries • Access to figures/costs of insurances • Costs depends upon surgeon, hospital, (univ. X 2)…

  27. CONCLUSIONS

  28. CONCLUSIONS (1) 1. Cost : 4105 Euro (54105 E), higher in female patients. The overall cost is higher in younger patients. Cost of ext fixation and plate fixation is higher then kapandji pinning. 2. In economically active patients, the most important predictive parameter is education level, prereduction shortening and injury compensation.

  29. CONCLUSIONS (2) 3. Permanent work incapacity is seen in 16% of the operatively treated cases. 4. A comprehensive view after DRF requires impairment and disability measurements.

  30. Thanks ! Dr P .Donceel, L. Desmet, M. Bossens, M. Dubois

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