Diagnostic scanning for suspected scaphoid fractures: An economic evaluation based on cost-minimisation models

Objective: To compare, the costs of diagnosing suspected scaphoid fractures using various protocols with various scanning techniques. Design: Analysis of the cost-minimisation models. The models were prepared after an audit of the existing protocol for suspected scaphoid fractures. Setting: Departments of Accident and Emergency and Orthopaedics, Leighton General Hospital, Crew, Cheshire, UK. Subjects: A total of 124 patients presenting to A&E with suspected scaphoid fractures between 1 December 1999 and 1 May 2000. Main outcome measures: Costs to the hospital budget in ruling out or diagnosing scaphoid fractures in these patients. Results: The cost using an existing protocol that does not routinely involve scanning was £15,554. Projected costs for many (but not all) of the alternative protocols involving routine use of scanning procedures were found to be lower or comparable. Conclusions: Protocols based on diagnostic scanning for suspected scaphoid fractures can be comparable to a protocol which does not rely on scanning techniques because they can avoid repeated radiographs, clinical appointments and plaster cast changes. However, any such protocol must be tailored on the basis of the workload, and the availability of resources. © 2002 Elsevier Science Ltd. All rights reserved.