Economic supplementary data

Matthew L Costa; Juul Achten; Susie Hennings; Nafisa Boota; James Griffin; Stavros Petrou; Mandy Maredza; Melina Dritsaki; Thomas Wood; James Masters; Ian Pallister; Sarah E Lamb; Nick R Parsons

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Costa ML, Achten J, Hennings S, et al. Intramedullary nail fixation versus locking plate fixation for adults with a fracture of the distal tibia: the UK FixDT RCT. Southampton (UK): NIHR Journals Library; 2018 May. (Health Technology Assessment, No. 22.25.)

$Cover of Intramedullary nail fixation versus locking plate fixation for adults with a fracture of the distal tibia: the UK FixDT RCT$

Intramedullary nail fixation versus locking plate fixation for adults with a fracture of the distal tibia: the UK FixDT RCT.

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Appendix 4Economic supplementary data

TABLE 35

Summary of unit cost data and data sources

Resource item	Unit cost (£)	Unit of analysis	Source of unit cost
Subsequent inpatient care
Orthopaedics (your leg)
Cost per average LoS of 1 day	1780.34	Per procedure	Reference Costs 2014–15; ‘minor knee procedures for non-trauma, 19 years and over’ – HN25A³³
Day case	1349.10	Per procedure	Reference Costs 2014–15; ‘minor knee procedures for non-trauma, 19 years and over’ – HN25A³³
Orthopaedics (any other bones)
Cost per average LoS of 4 days	2648.56	Per procedure	Reference Costs 2014–15; ‘other muscle, tendon, fascia or ligament procedures’ – HN93Z³³
Day case	965.19	Per procedure	Reference Costs 2014–15; ‘other muscle, tendon, fascia or ligament procedures’ – HN93Z³³
Adjustment per day ± average LoS (excess bed-days)	278.52	Per day	Reference Costs 2014–15; ‘other muscle, tendon, fascia or ligament procedures’ – HN93Z³³
Other inpatient
Rehabilitation unit	335.00	Per session	Reference Costs 2013–14; ‘rehabilitation for other trauma’ – V636Z⁴⁹
Outpatient care
Orthopaedics	112.50	Per session	Reference Costs 2014–15³³
Blood tests/phlebotomy	3.00	Per test	Reference Costs 2014–15³³
Radiology
Radiography	30.23	Per test	Reference Costs 2014–15³³
Magnetic resonance imaging	146.00	Per test	Reference Costs 2014–15³³
Computerised tomography	111.00	Per test	Reference Costs 2014–15³³
Hospital physiotherapist (NHS)	38.00	Per session	Unit Costs of Health and Social Care 2015, p. 217 ³⁴
Physiotherapist (private)	70.00	Per hour	The Physio Centre (URL: www.thephysiocentre.co.uk/how_much/; accessed 3 October 2017)
Emergency department
Orthopaedics and trauma	112.50	Per session	Reference Costs 2014–15³³
Other	140.59	Per session	Reference Costs 2014–15³³
Primary and community care
GP
Surgery consultation	225.00	Per hour	Unit Costs of Health and Social Care 2015, p. 178³⁴
Home visit	5.20	Per home visit minute	Unit Costs of Health and Social Care 2010, p. 167⁵⁰
Telephone call	27.00	Per telephone consultation lasting 7.1 minutes	Unit Costs of Health and Social Care 2015, p. 178³⁴
Practice nurse	56.00	Per hour of face-to-face contact	Unit Costs of Health and Social Care 2015, p. 174³⁴
District nurse	67.00	Per hour of patient related work	Unit Costs of Health and Social Care 2015, p. 169³⁴
Community physiotherapist	36.00	Per hour of consultation	Unit Costs of Health and Social Care 2015, p. 179³⁴
Occupational therapist	44.00	Per hour	Unit Costs of Health and Social Care 2015, p. 191³⁴
PSS
Meals on Wheels
Frozen, daily	46.00	Per weekly meal	Unit Costs of Health and Social Care 2014, p. 127⁵¹
Hot, daily	44.00	Per weekly meal	Unit Costs of Health and Social Care 2014, p. 127⁵¹
Laundry services	4.55	Per load	North Yorkshire Country Council (URL: www.northyorks.gov.uk/article/23988/Paying-for-social-care-services-in-the-community; accessed 3 October 2017)
Social worker contacts	42.00	Per hour	Unit Costs of Health and Social Care 2015, p. 95³⁴
Care worker contacts including help at home	24.00	Per hour	Unit Costs of Health and Social Care 2015, p. 192³⁴
Aids and adaptations
Crutches	5.06	Per unit	NHS Supply Chain 2016 (URL: https://my.supplychain.nhs.uk/catalogue; accessed 3 October 2017)
Stick	3.94	Per unit	NHS Supply Chain 2016 (URL: https://my.supplychain.nhs.uk/catalogue; accessed 18 July 2016)
Walking frame	35.99	Per unit	NHS Supply Chain 2016 (URL: https://my.supplychain.nhs.uk/catalogue; accessed 18 July 2016)
Grab rail	1.61	Per unit	NHS Supply Chain 2016 (URL: https://my.supplychain.nhs.uk/catalogue; accessed 18 July 2016)
Dressing aids	1.66	Per unit	NHS Supply Chain 2016 (URL: https://my.supplychain.nhs.uk/catalogue; accessed 18 July 2016)
Long-handle shoe horn	1.66	Per unit	NHS Supply Chain 2016 (URL: https://my.supplychain.nhs.uk/catalogue; accessed 18 July 2016)
Productivity losses
Median wage rate
Full time, male	567.00	Per week	Annual Survey of Hours and Earnings: 2015³⁶
Full time, female	471.00	Per week	Annual Survey of Hours and Earnings: 2015³⁶
Part time, male	156.00	Per week	Annual Survey of Hours and Earnings: 2015³⁶
Part time, female	171.00	Per week	Annual Survey of Hours and Earnings: 2015³⁶
Median earnings (self-employed)	10,800.00	Per year	The Income of the Self-Employed⁵²

: GP, general practitioner; LoS, length of stay.

TABLE 36

Number and proportion of individuals with missing health economic data by treatment allocation

Variable	Description	Treatment group, missing values, n (%)
Variable	Description	IM nail fixation (n = 158)	Locking plate (n = 160)	Total
eq5db	EQ-5D index score pre injury	1 (1)	1 (1)	2 (1)
eq5d0	EQ-5D index score post injury	2 (1)	3 (2)	5 (2)
eq5d1	EQ-5D at 3 months	23 (15)	19 (12)	42 (13)
eq5d2	EQ-5D at 6 months	16 (10)	18 (11)	34 (11)
eq5d3	EQ-5D at 12 months	43 (27)	42 (26)	85 (27)
c0	Operative costs (surgery cost including initial hospital stay and implants)	0 (0)	0 (0)	0 (0)
c1	Total resource use between baseline and 3 months	54 (34)	54 (34)	108 (34)
c2	Total resource use between 3 and 6 months	30 (19)	31 (19)	61 (19)
c3	Total resource use between 6 and 12 months	60 (38)	58 (36)	118 (37)
c4	Total resource use between 0 and 6 months	67 (42)	62 (39)	129 (41)
c5	Total resource use between 0 and 12 months	88 (56)	82 (51)	170 (54)

TABLE 37

Use of health-care resources related to distal fracture fixation by each follow-up period and treatment arm (complete cases)

Health-care resource	Treatment group		Difference: p-value of t-test
Health-care resource	IM nail fixation	Locking plate	Difference: p-value of t-test
Six-week follow-up
Inpatient care, mean length of stay in days (SE)
Intensive care	0.11 (0.06)	0.41 (0.39)	0.45
Acute trauma	5.78 (0.36)	5.83 (0.35)	0.92
Rehabilitation	0.55 (0.30)	0.19 (0.09)	0.26
Other	0.17 (0.07)	0.21 (0.12)	0.78
Total inpatient care use	6.61 (0.47)	6.64 (0.39)	0.62
Proportion of participants prescribed antibiotics at 6 weeks (SD)	0.14 (0.35)	0.13 (0.03)	0.69
Three-month follow-up
Subsequent inpatient care, mean length of stay in days (SE)
Orthopaedics
Leg	0.09 (0.05)	0.18 (0.12)	0.25
Other bones	0	0
Rehabilitation unit	0	0.09 (0.09)	0.16
Other
Surgery	0.03 (0.03)	0.11 (0.11)	0.24
Non-surgery	0	0.01 (0.01)	0.16
Total inpatient care use	0.12 (0.06)	0.38 (0.24)	0.16
Outpatient care, mean number of contacts (SE)
Orthopaedics	1.66 (0.12)	1.93 (0.15)	0.09
Pathology	0.07 (0.03)	0.08 (0.03)	0.85
Radiology
Radiography	1.26 (0.21)	1.38 (0.11)	0.21
Magnetic resonance imaging	0.01 (0.01)	0.03 (0.01)	0.09
Computerised tomography	0	0.03 (0.01)	0.02
Physiotherapy
NHS	1.82 (0.21)	1.69 (0.19)	0.67
Private	3.59 (3.26)	0.16 (0.10)	0.86
Emergency department
Fracture related	0.10 (0.03)	0.08 (0.03)	0.66
Other reasons	0.02 (0.01)	0.03 (0.02)	0.25
Other	0.06 (0.02)	0.08 (0.03)	0.30
Total outpatient care use	8.59 (3.25)	5.50 (0.33)	0.83
Community health care, mean number of contacts (SE)
GP contacts
Surgery consultation	0.92 (0.13)	0.97 (0.16)	0.39
Home visit	0.14 (0.06)	0.11 (0.05)	0.62
Telephone call	0.36 (0.10)	0.46 (0.10)	0.24
Practice nurse contacts	0.64 (0.19)	0.39 (0.10)	0.88
District nurse contacts	2.61 (0.92)	1.13 (0.49)	0.92
Community physiotherapy contacts	0.59 (0.15)	0.71 (0.18)	0.31
Occupational therapy contacts	0.29 (0.13)	0.26 (0.11)	0.56
Other	0.10 (0.10)	0.22 (0.17)	0.27
Total community health-care use	5.64 (0.97)	4.25 (0.56)	0.89
Aids and adaptations, mean count (SE)
Crutches	1.05 (0.09)	1.21 (0.10)	0.11
Stick	0.12 (0.03)	0.06 (0.03)	0.91
Walking frame	0.20 (0.04)	0.34 (0.06)	0.03*
Grab rail	0.12 (0.04)	0.09 (0.04)	0.70
Dressing aids	0.33 (0.24)	0.11 (0.08)	0.80
Long-handle shoe horn	0.03 (0.02)	0.01 (0.01)	0.81
Other	0.70 (0.10)	0.68 (0.10)	0.57
Total use – aids and adaptations	2.55 (0.30)	2.51 (0.18)	0.65
Medicines, proportion of participants prescribed each class of drug (SD)
Analgesics	0.58 (0.35)	0.56 (0.37)	0.60
Antibiotics	0.08 (0.19)	0.13 (0.0.28)	0.34
Anti-inflammatories	0.14 (0.0.21)	0.16 (0.0.27)	0.24
Anticoagulant	0.05 (0.16)	0.03 (0.14)	0.84
Anti-inflammatory gels	0.01 (0.06)	0 (0.04)	0.74
Other	0.15 (0.29)	0.11 (0.25)	0.82
All medicines	1.00	1.00	0.98
PSS, number of contacts (SE)
Laundry services	0	0
Social worker contacts	0	0.01 (0.01)	0.16
Care worker/home help	0.43 (0.43)	0.74 (0.56)	0.33
Other	0.60 (0.42)	0	0.92
Total PSS use	1.02 (0.60)	0.75 (0.56)	0.63
Productivity losses (SD)
Number of days off work	46.12 (4.21)	54.46 (3.72)	0.07*
Six-month follow-up
Subsequent inpatient care, mean length of stay in days (SE)
Orthopaedics
Leg	0	0.08 (0.08)	0.04
Other bones	0	0
Rehabilitation unit	0	0
Other
Surgery	0	0.03 (0.03)	0.16
Non-surgery	0	0.01 (0.01)
Total inpatient care use	0	0.11 (0.06)	0.03**
Outpatient care, mean number of contacts (SE)
Orthopaedics	0.71 (0.10)	1.17 (0.25)	0.04
Pathology	0.05 (0.02)	0.02 (0.02)	0.89
Radiology
Radiography	0.53 (0.09)	0.71 (0.10)	0.1
Magnetic resonance imaging	0.01 (0.01)	0.01 (0.01)	0.5
Computerised tomography	0.02 (0.01)	0.02 (0.01)	0.5
Physiotherapy
NHS	1.84 (0.28)	2.53 (0.36)	0.07*
Private	0.27 (0.12)	0.12 (0.06)	0.88
Emergency department
Fracture related	0.02 (0.01)	0.01 (0.01)	0.72
Other reasons	0.02 (0.01)	0.07 (0.05)	0.18
Other	0.16 (0.09)	0.13 (0.06)	0.59
Total outpatient care use	3.64 (0.35)	4.78 (0.53)	0.04**
Community health care
GP contacts
Surgery consultation	1.09 (0.18)	0.89 (0.25)	0.74
Home visit	0.06 (0.04)	0.11 (0.08)	0.30
Telephone calls	0.18 (0.09)	0.14 (0.08)	0.62
Practice nurse contacts	0.06 (0.04)	0.07 (0.05)	0.43
District nurse contacts	0.18 (0.13)	0.43 (0.43)	0.29
Community physiotherapy contacts	1.70 (0.59)	1.04 (0.38)	0.82
Occupational therapy contacts	0.15 (0.09)	0.46 (0.43)	0.24
Other	0.15 (0.10)	0.54 (0.37)	0.16
Total community health-care use	3.58 (0.61)	3.68 (0.67)	0.46
Aids and adaptations
Crutches	0.16 (0.04)	0.19 (0.05)	0.32
Stick	0.09 (0.03)	0.05 (0.02)	0.91
Walking frame	0.02 (0.01)	0.04 (0.02)	0.26
Grab rail	0.06 (0.04)	0.01 (0.01)	0.90
Dressing aids	0.03 (0.03)	0	0.84
Long-handle shoe horn	0.01 (0.01)	0	0.84
Other	0.09 (0.04)	0.13 (0.04)	0.24
Total use – aids and adaptations	0.47 (0.12)	0.41 (0.09)	0.65
Medicines, proportion prescribed each class of drug (SD)
Analgesics	0.51 (0.45)	0.56 (0.46)	0.32
Antibiotics	0.08 (0.24)	0.13 (0.34)	0.50
Anti-inflammatories	0.07 (0.23)	0.02 (0.10)	0.79
Anticoagulant	0.01 (0.08)	0.01 (0.05)	0.50
Anti-inflammatory gels	0.06 (0.23)	0.04 (0.18)	0.68
Other	0.27 (0.42)	0.25 (0.39)	0.58
All medicines	1.00	1.00
PSS, number of contacts (SE)
Laundry services	0	0
Social worker contacts	0	0
Care worker/home help	2.43 (1.75)	0.71 (0.71)	0.82
Other	0	0
Total PSS use	2.43 (1.75)	0.71 (0.71)	0.82
Productivity losses (SD)
Number of days off work	24.59 (5.22)	32.80 (5.89)	0.15
Twelve-month follow-up
Subsequent inpatient care, mean length of stay in days (SE)
Orthopaedics
Leg	0.16 (0.10)	0.15 (0.09)	0.95
Other bones	0	0
Rehabilitation unit	0	0
Other
Surgery	0.01 (0.01)	0.10 (0.08)	0.28
Non-surgery	0	0
Total inpatient care	0.17 (0.11)	0.25 (0.15)	0.71
Outpatient care, mean number of contacts (SE)
Orthopaedics	0.46 (0.13)	0.71 (0.18)	0.28
Pathology	0.13 (0.07)	0.27 (0.17)	0.46
Radiology
Radiography	0.38 (0.09)	0.30 (0.08)	0.50
Magnetic resonance imaging	0	0.03 (0.01)	0.08
Computerised tomography	0. 75 (0.46)	0.11 (0.06)	0.17
Physiotherapy
NHS	0.55 (0.22)	0.70 (0.28)	0.67
Private	0.07 (0.05)	0.07 (0.05)	0.97
Emergency department
Fracture related	0.03 (0.02)	0.17 (0.16)	0.36
Other reasons	0.01 (0.01)	0. 03 (0.03)	0.38
Other	0.10 (0.03)	0.31 (0.21)	0.33
Total outpatient care use	2.47 (0.71)	2.70 (0.58)	0.80
Community health care, mean number of contacts (SE)
GP contacts
Surgery consultation	0.91 (0.26)	1.64 (0.37)	0.11
Home visit	0.06 (0.04)	0	0.16
Telephone call	0.91 (0.75)	0.03 (0.03)	0.25
Practice nurse contacts	0.09 (0.07)	0.42 (0.20)	0.14
District nurse contacts	0	0
Community physiotherapy contacts	0.69 (0.33)	1.11 (0.59)	0.54
Occupational therapy contacts	0	0.89 (0.68)	0.20
Other	0.09 (0.09)	0.28 (0.22)	0.45
Total community health-care use	2.75 (0.95)	4.36 (1.02)	0.25
Aids and adaptations, mean number of items (SE)
Crutches	0.13 (0.05)	0.06 (0.03)	0.30
Stick	0.03 (0.02)	0.07 (0.02)	0.13
Walking frame	0	0.02 (0.01)	0.58
Grab rail	0.01 (0.01)	0.02 (0.01)	0.10
Dressing aids	0.02 (0.02)	0	0.32
Long-handle shoe horn	0	0.02 (0.01)	0.16
Other	0.14 (0.05)	0.10 (0.04)	0.53
Total use – aids and adaptations	0.35 (0.09)	0.27 (0.07)	0.45
Medicines, proportion prescribed each class of drug (SD)
Analgesics	0.55 (0.43)	0.47 (0.42)	0.73
Antibiotics	0.08 (0.24)	0.05 (0.14)	0.66
Anti-inflammatories	0.20 (0.34)	0.19 (0.35)	0.42
Anticoagulant	0.03 (0.11)	0	0.84
Anti-inflammatory gels	0.08 (0.24)	0	0.91
Other	0.08 (0.24)	0.29 (0.43)	0.03**
All medicines	1.00	1.00
PSS, mean number of contacts (SE)
Laundry services	0	0.02 (0.02)	0.16
Social worker contacts	0.01 (0.01)	0.04 (0.04)	0.24
Care worker/home help	0	0.01 (0.01)	0.16
Other	0	0.01 (0.01)	0.16
Total PSS use	0.01 (0.01)	0.08 (0.05)	0.09*
Productivity losses (SD)
Mean number of days off work	12.99 (5.84)	15.59 (4.91)	0.73

: *, significant at the 5% level; **, significant at the 10% level.
: GP, general practitioner.

Copyright © Queen’s Printer and Controller of HMSO 2018. This work was produced by Costa et al. under the terms of a commissioning contract issued by the Secretary of State for Health and Social Care. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK.

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Costa ML, Achten J, Hennings S, et al. Intramedullary nail fixation versus locking plate fixation for adults with a fracture of the distal tibia: the UK FixDT RCT. Southampton (UK): NIHR Journals Library; 2018 May. (Health Technology Assessment, No. 22.25.) Appendix 4, Economic supplementary data.
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