Exploring the cost-effectiveness of 3-D-guided versus traditional 2-D corrective osteotomy in patients with a distal radius malunion.

Distal radius malunion is a frequent complication after a distal radius fracture, impairing function and quality of life. Corrective osteotomy using conventional two-dimensional (2-D) planning often fails to achieve optimal alignment, leading to residual symptoms and revision surgery. Growing evidence shows that three-dimensional (3-D) planning with patient-specific surgical guides has better radiographic and clinical outcomes and fewer complications, but at increased upfront costs. We developed a health state transition model to assess the cost-effectiveness of 3-D versus 2-D based surgery in the Netherlands over a five-year time horizon from a societal perspective. Clinical outcomes of 3-D, including transition probabilities, were obtained from a clinical cohort, whereas literature informed 2-D transition probabilities. Literature was used to obtain costs, and utility values. Outcomes of interests were the number of revisions, quality-adjusted life years (QALYs) and societal costs in each strategy. All 3-D analyses and guide development were performed in our in-house 3-D lab. Notably, revisions performed for nonunion or implant failure were reduced by 179 per 1,000 patients in the 3-D strategy. Overall, 3-D yielded slightly higher QALYs (+ 0.007) and lower costs (-€219), primarily due to fewer revisions performed for nonunion or implant failure and reduced productivity losses. Using this model, 3-D-guided corrective osteotomy (supported by an in-house 3-D lab) is anticipated to be cost-effective versus 2-D-planned corrective osteotomy from a Dutch societal perspective; it potentially yields a modest improvement in health outcomes alongside a slight reduction in costs. However further clinical validation, including prospective collection of clinical outcome data, is needed to confirm these findings in real-world practice. Three-dimensional planning with patient-specific surgical guides for correcting distal radius malunion may lead to slightly better patient health outcomes while also reducing overall societal costs compared with conventional two-dimensional planning. The main benefits come from substantially fewer revision surgeries and lower productivity losses, despite higher upfront planning costs. Overall, this approach appears to be a cost-effective alternative, although further clinical validation is still needed.