In a unique combined study, researchers from multiple institutions across the United Kingdom compared a removable boot with plaster cast for the treatment of ankle fractures 2 weeks after surgery with weight bearing as able. They used data from 243 trial participants and reviewed medical notes to estimate costs from both the National Health Service (NHS) and Personal Social Services (PSS). In addition, the study was strengthened by a nested qualitative study that explored the impact of both treatments on participants’ activities of daily living. Primary outcome was quality-adjusted life years (QALYs).
The boot group cost, on average, was ₤88 (CI ₤22 to ₤155; [$112USD; CI $28 to $197]) per patient more than in the plaster cast group from the payer perspective (NHS and PSS). When including all societal costs, the boot saved, on average, £676 per patient (95% CI −£337 to £1689). Although there was no evidence of a QALY difference between the groups (−0.0020 (95% CI −0.0067 to 0.0026)), the qualitative findings suggest participants felt the boot enhanced their quality of life. Patients in the boot felt more independent and empowered to take on family responsibilities and social activities.
The authors concluded that while the removable boot is slightly more expensive than plaster cast for the NHS+PSS payer at 12 weeks after surgery, it reduces productivity losses and the need for informal care while empowering patients. Given that differences in QALYs and costs to the NHS are small, the decision to use a boot or plaster following ankle surgery could be left to patients’ and clinicians’ preferences.
Source: Baji P, Barbosa EC, Heaslip V, et al. Use of removable support boot versus cast for early mobilization after ankle fracture surgery: cost-effectiveness analysis and qualitative findings of the Ankle Recovery Trial (ART). BMJ Open 2024;14:e073542. doi:10.1136/bmjopen-2023-073542
