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Wrist & Hand

Cost-utility analysis of surgical fixation with Kirschner wire versus casting after fracture of the distal radius

a health economic evaluation of the DRAFFT2 trial

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The aim of this study was to compare the cost-effectiveness of surgical fixation with Kirschner (K-)wire ersus moulded casting after manipulation of a fracture of the distal radius in an operating theatre setting.


An economic evaluation was conducted based on data collected from the Distal Radius Acute Fracture Fixation Trial 2 (DRAFFT2) multicentre randomized controlled trial in the UK. Resource use was collected at three, six, and 12 months post-randomization using trial case report forms and participant-completed questionnaires. Cost-effectiveness was reported in terms of incremental cost per quality-adjusted life year (QALY) gained from an NHS and personal social services perspective. Sensitivity analyses were conducted to examine the robustness of cost-effectiveness estimates, and decision uncertainty was handled using confidence ellipses and cost-effectiveness acceptability curves.


In the base case analysis, surgical fixation with K-wire was more expensive (£29.65 (95% confidence interval (CI) -94.85 to 154.15)) and generated lower QALYs (0.007 (95% CI -0.03 to 0.016)) than moulded casting, but this difference was not statistically significant. The probability of K-wire being cost-effective at a £20,000 per QALY cost-effectiveness threshold was 24%. The cost-effectiveness results remained robust in the sensitivity analyses.


The findings suggest that surgical fixation with K-wire is unlikely to be a cost-effective alternative to a moulded cast in adults, following manipulation of a fracture of the distal radius in a theatre setting.

Cite this article: Bone Joint J 2022;104-B(11):1225–1233.

Correspondence should be sent to Matthew L. Costa. E-mail:

DRAFFT2 collaborators: Jonathan A Cook, Melina Dritsaki, Helen Dakin, Jonathan Jones, Andrew Mckee Kevin Smith, Mohamed Hamadto, Steve Gwilym, Tim Chesser, Jaime Candal-Couto, Caroline Hing, David Giddin, Phil Johnston, Aamer Ullah, John Williams, Will Eardley, Makaram Srinivasan, Sridharrao Sampalli, Mark Farrar, Chris Roberts, Khitish Mohanty, Iain MacLeod, Praveen Sarda, Amr Elseehy, Nigel Rossiter, David Warwick, Chris Peach, David MacKay, Richard Benson, Adam Watts, Jonathan Young, Feisal Shah, Stephen Lipscombe, Aaron Ng, Bambos Charalambous, Barnaby Sheriden, Kanthan Theivendran, Pulimamidi Sanjay, Rajesh Nanda, Antony Bateman, Michael Butler, Oliver Keast-Butler, Andrew McAndrew, Wystan Chevannes, Pradeep Kankanalu, Asanka Wijendra, Andreas Fontalis, Hytham Afifi, Marie-Clare Killen, Ryan Higgin, Warran Wignadasan, Ken Wong, Catherine Gibson, Harry Beale, Bob Jennings, James Kennedy, Mark Williamson, Damir Rasidovic, Lydia Jenner, John Baha Tadros, Steve Milner, James Duncan, Sally Kerr, Louise Nordin, Matt Weston, Olivia Payton, Tofi Oni, Craig Zhao, Sukhdeep Gill, Mohammad Iqbal, Marie-Clare Killen, Khaled Aneiba, Warran Wignadasan, Dilip Pillai, Luke Hughes, Jonathan Crosby, Mike Whitehouse, Thomas Corbett, Arshad Iqbal, Steph Buchan, Laura Beddard, Venkat Vardhan, Becky Beamish, Matt Jones, Jonathan Holley.

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