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Economic Aspects in Bone Healing

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1 Economic Aspects in Bone Healing
W. Schaden, Trauma Center Meidling / Vienna Ludwig Boltzmann Institute for Experimental and Clinical Traumatology

2 in seven AUVA- Trauma Centers from 2005 - 2009
ESWT for Non-Union Fractures – Economic Aspects Diagnosis: Fractures versus Pseudarthrosis in seven AUVA- Trauma Centers from Dia. 2005 2006 2007 2008 2009 total Fracture 45.077 45.580 44.940 46.079 43.073 Pseudarthrosis 1.163 1.126 1.168 1.257 992 5.706 % 2,58 2,47 2,59 2,72 2,30 2,53

3 ESWT for Non-Union Fractures – Economic Aspects
in one year in Austria (~ 8 Mio inhabitants) ~ (0,05%) fractures are reported, of which ~ develop non-unions: (2,5%)

4 University of Economics in Vienna (Studiendekan Prof. Dkfm. Dr. W
University of Economics in Vienna (Studiendekan Prof. Dkfm. Dr. W. Kemmetmüller) first op 68% success non-union cons. therapy d op success? second op 23% impl. rem. third op 7% d Amputation 2% d

5 ESWT for Non-Union Fractures – Economic Aspects
op 25 % ESWT d Success ~ 75 % second op d impl. rem. third op amputation d

6 Shockwave Treatment of Non-Unions: Economical considerations
ESWT for Non-Union Fractures – Economic Aspects Shockwave Treatment of Non-Unions: Economical considerations 65% - 75% (6.500 – 7.500) of the non-unions are suitable for shock wave therapy (~ non-unions per year).

7 Approximately Costs for non-unions treatment in Austria
ESWT for Non-Union Fractures – Economic Aspects Approximately Costs for non-unions treatment in Austria one op (incl. impl. rem.) € ,- two op (incl. impl. rem.) € ,- three op (incl. impl. rem.) € ,- + amputation € ,- ESWT € ,-

8 Comparison of costs of 7.000 non-unions
ESWT for Non-Union Fractures – Economic Aspects Comparison of costs of non-unions one op (68%) à € ,-/ ,- two op (23%) à € ,-/ ,- three op ( 7%) à € ,-/ ,- + amput ( 2%) à € ,-/ ,- total: ,-

9 Comparison of costs of 7.000 non-unions
ESWT for Non-Union Fractures – Economic Aspects Comparison of costs of non-unions ESWT (75%) à € ,-/ ,- 2. ESWT (25%) à € ,-/ ,- not healed (25%) à € ,-/ ,- 1.750 (25%) non-unions => „standard of care“ one op (68%) à € ,-/ ,- two op (23%) à € ,-/ ,- three op (7%) à € ,-/ ,- + amputation (2%) à € ,-/ ,- total ,-

10 ESWT for Non-Union Fractures – Economic Aspects
By treating non-unions a year with ESWT the treatment costs could be reduced as follows € ,- - € ,- € ,- (~ 66%) Not included are the savings due to shorter sick leave and lower insurance costs.

11 for Non-Union Treatment??
“Gold Standard” for Non-Union Treatment??

12 How many fractures per year do you estimate do occur in an average population in %?
a, 0,1% = 1 out of b, 0.05% = 5 out of c, 0,01% = 1 out of d, 0,005% = 5 out of How many pseudarthroses (non-unions) do heal on an average after a single surgical procedure (data from social insurance)? a, 68% b, 78% c, 88% d, 98% Austria has to deal with ~ non-unions per year. If every patient would receive ESWT instead of surgery the amount of money to be saved would be a, € b, € c, € d, €


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