A clinical and economic evaluation of magnetic intramedullary lengthening nails for femoral lengthening in children compared to external fixators.

The limited resources and ongoing financial pressures which face the National Health Service necessitate economic evaluation to justify the decision-making and allocation of resources. Cost-utility analysis although is one of the most useful types of economic evaluation is not particularly common in paediatric orthopaedics. This study outlines the concepts of cost-utility analysis and applies them to evaluate an intervention for femoral lengthening in children.
Femoral lengthening is a procedure of great importance in the treatment of congenital and acquired limb deficiencies. If left untreated these conditions could result in many physical and emotional problems to the patients. Femoral lengthening surgeries used to rely on external fixation to achieve the required length and to stabilise the bones until satisfactory healing is achieved. Technological advances have led to the design of fully implantable motorized intramedullary lengthening nails, which are reported to avoid some complications of external fixations. Nevertheless, lengthening nails implants are more expensive than external fixators.
This thesis presents a cost-utility analysis of femoral lengthening in children with intramedullary magnetic lengthening nails compared to external fixators.
No previous literature evaluated the costs or the quality-of-life outcomes of the interventions. The clinical effectiveness and the costs of treatment with the intramedullary lengthening nails and external fixators were compared retrospectively in age and diagnosis matched cohorts. While the health utilities were compared prospectively between two different cohorts.
Intramedullary magnetic lengthening nails have the potential to be a safe and effective option for femoral lengthening in children. The lower cost of post-operative care may be enough to outweigh the higher cost of the lengthening nail implants. When compared to external fixation devices, lengthening nails provide a higher quality of life throughout the treatment process. Within the National health care services setup, paediatric femoral lengthening with PRECICE nails was determined to be cost-effective.