The impact of the AO foundation on fracture care : an evaluation of 60 years AO foundation

Objectives Sixty years ago, the Association of Osteosynthesis (AO) was founded with the aim to improve fracture treatment and has since grown into one of the largest medical associations worldwide. Aim of this study was to evaluate AO's impact on science, education, patient care and the MedTech business. Design/methods Impact evaluations were conducted as appropriate for the individual domains: Impact on science was measured by analyzing citation frequencies of publications promoted by AO. Impact on education was evaluated by analyzing the evolution of number and location of AO courses. Impact on patient care was evaluated with a health economic model analyzing cost changes and years of life gained through the introduction of osteosynthesis in 17 high-income countries (HICs). Impact on MedTech business was evaluated by analyzing sales data of AO-associated products. Results Thirty-five AO papers and 2 major AO textbooks are cited at remarkable frequencies in high ranking journals with up to 2000 citations/year. The number of AO courses steadily increased with a total of 645'000 participants, 20‘000 teaching days and 2‘500 volunteer faculty members so far. The introduction of osteosynthesis saved at least 925 billion Swiss Francs [CHF] in the 17 HICs analyzed and had an impact on avoiding premature deaths comparable to the use of antihypertensive drugs. AO-associated products generated sales of 55 billion CHF. Conclusion AO's impact on science, education, patient care, and the MedTech business was significant because AO addressed hitherto unmet needs by combining activities that mutually enriched and reinforced each other

Impact of osteosynthesis in fracture care : a cost comparison study

Aim: To estimate the health economic impact of osteosynthesis (OS) in fracture care over six decades in 17 high-income countries. Patients & methods: Applying a decision tree model, we assumed a hypothetical absence of OS and compared OS (intervention) with conservative treatment (CONS; comparator). We included patients with femur, tibia and radius fractures (age <65 years) and for proximal femur fractures also elderly patients (≥70 years). Results: We estimated savings in direct and indirect costs of 855 billion Swiss francs in the working age population in addition to 4.6 million years of life gained. In the elderly population, 69 billion Swiss francs were saved in direct costs of proximal femur fractures in addition to 73 million years of life gained. Conclusion: OS contributed to maximize health gains of society

Health technology assessment : self-measurement of blood glucose in patients with non-insulin treated diabetes mellitus type 2

Background: The value of SMBG in non-insulin treated T2DM patients is unclear. We performed a full-HTA to assess patient benefit and cost-effectiveness, as well as ethical and socio-legal aspects of SMBG. Research question: What is the effect on HbA1c and cost-effectiveness of adding SMBG to usual care in adult non-insulin treated T2DM compared to usual care without SMBG? Methods: We performed literature searches, quantitative and qualitative evidence synthesis. For our economic analysis we used a diabetes simulation modelling approach (UKPDS-OM2). Results: We retrieved 2,882 records and included 24 RCTs and 10 economic studies. Comparing several SMBG protocols of the intervention groups with no, less frequent or less struc-tured SMBG leads to a statistically significant HbA1c decrease of -0.29%-points (95%CI: -0.40 to -0.18; 23 RCT; low certainty of evidence). Based on our model, this HbA1c decrease translates into small but statistically significant reductions in several diabetes related complications. SMBG leads to a modelled increase in life expectancy of 18 days (95%-CI: 13 to 25) with increased total costs of CHF 2,910 (95%-CI: 2,750 to 3,021) over a time horizon of 40 years. Based on this small health benefit and on the low total additional costs, SMBG has a formal ICER of CHF 65,023 per QALY gained. In studies without any SMBG in the control group, the HbA1c decrease is more pronounced (-0.33%-points; 95%CI: -0.45 to -0.21; 17 RCT). SMBG is more cost-effective with the ICER decreasing to CHF 41,078 per QALY gained. SMBG was associated with a significantly increased probability of detecting hypoglycaemia (RR 2.10; 95%-CI: 1.41 to 3.15; 4 RCTs with high proportions of patients treated with sulfonylureas; episodes of mild and non-severe nature; moderate quality of evidence). SMBG increases the prob-ability of «being in HbA1c target» (RR 2.78; 95%-CI: 1.46 to 5.31; 5 RCTs; low quality of evidence). No relevant differences were seen in the RCTs for psychological outcomes (e.g. depressive symp-toms, quality of life, patient satisfaction with treatment [moderate to high certainty evidence]), mor-bidity, mortality, and unexpected events and harms [low certainty of evidence]). Only 1 in 4 non-insulin treated patients with T2DM in Switzerland bought SMBG test strips in 2017 and most of those buying test strips bought substantially less than the maximum amount reimbursed. A total elimination of test strip coverage for non-insulin treated T2DM patients would lead to net savings of CHF 6.09 million per year (budget impact) from a Swiss healthcare payers’ perspective. Organisational issues of relevance are proper documentation of SMBG results by patients (possibly supported by smartphone applications) and adequate handling of SMBG by vulnerable groups (e.g. elderly persons with visual dysfunction or limited motor skills). From a socio-legal perspective, re-stricting the provision of blood glucose test strips to a certain group of patients must be based on objective reasons (WZW criteria on the basis of the HTA), but may under no circumstances be unilaterally at the expense of vulnerable groups. From an ethical perspective, the evidence base to question current best practices appears to be scant: SMBG is associated with a slight improvement of HbA1c levels, but it is unclear to which extent this result is also clinically relevant. At a psycho-logical level, SMBG allows a higher degree of participation of patients in the care process, but there is no clear evidence about improved psychological outcomes in the target population. Conclusions: SMBG shows modest efficacy on HbA1c levels in RCTs. Model calculations based on this finding suggest a resulting small increase in life expectancy. However, since this has so far not been evaluated in clinical studies, this outcome cannot be confirmed nor rebutted

Versorgung von Unfallpatienten durch die Hausarztpraxis : zentrale Anlaufstelle, breites Verletzungsspektrum

Hausärztinnen und Hausärzte sind zentrale Anlaufstellen bei der Versorgung von Unfallpatienten. Bei 54 % der Unfälle leisten sie Erstversorgung, bei 41 % sind sie gar Alleinversorger, d. h. sie führen alle notwendigen Untersuchungen und Behandlungen durch. Es erstaunt deshalb nicht, dass Hausarztpraxen mit einem breiten Spektrum an Verletzungen konfrontiert sind. Traumatologische Fähigkeiten wie Nähen, Gipsen oder Schienen sind deshalb wichtige Bestandteile der hausärztlichen Weiterbildung