Q: Can you tell us about your latest publication?
A: We’re pleased to share our recent study, “Cost-effectiveness of Surgery versus Functional Bracing for Humeral Shaft Fractures in Adults,” published in The Journal of Bone & Joint Surgery. This work is a prespecified economic evaluation conducted alongside the Finnish Shaft of the Humerus (FISH) randomized clinical trial. It adds an important economic perspective to the ongoing discussion about how best to treat these injuries.
Q: What motivated this study?
A: Previous evidence, including results from the FISH trial and another recent randomized controlled trial(*1), has shown that surgical fixation and functional bracing lead to similar long-term functional outcomes in patients with displaced humeral shaft fractures. However, clinical equivalence doesn’t automatically mean the treatments are equal in terms of cost. Especially for working-age patients, factors like the risk of secondary surgery and time away from work can have significant economic consequences.
Q: What was the main question your study aimed to answer?
A: We wanted to address a straightforward but important question: which treatment provides better value when you consider not only direct medical costs but also broader economic impacts? To do this, we combined clinical trial data with detailed cost information from national registries and hospital pricing systems. This allowed us to perform the first trial-based cost-effectiveness analysis comparing surgery and functional bracing from both a societal and a healthcare system perspective.
Q: What were the key findings?
A: The findings highlight a clear divergence between these viewpoints. When productivity losses were included, surgery was not only more effective but also cost-saving overall, largely due to a lower risk of prolonged work absence. In contrast, when the analysis was limited to direct medical expenditures, functional bracing remained the less costly option.
Q: How should clinicians and patients interpret these findings?
A: While both treatments lead to similar functional outcomes after about six months, the economic perspective adds an important layer. From a broader health-economic standpoint, surgery may be the more favorable option for working-age patients because it reduces productivity losses. On the other hand, functional bracing may be more appropriate for individuals who are less impacted by time away from work or who prefer to avoid the risks associated with surgery.
Reference:
1) Oliver WM, Bell KR, Carter TH, et al. Operative vs Nonoperative Management of Fractures of the Humeral Diaphysis: The Humeral Shaft Fracture Fixation Randomized Clinical Trial. JAMA Surg. Mar 26 2025; doi:10.1001/jamasurg.2025.0301
Stay up to date
Follow FICEBO on social media to stay in the loop with our latest updates.
