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

The Comprehensive AOCMF classification system : radiological issues and systematic approach

The AOCMF Classification Group developed a hierarchical three-level craniomaxillofacial (CMF) classification system with increasing level of complexity and details. The basic level 1 system differentiates fracture location in the mandible (code 91), midface (code 92), skull base (code 93), and cranial vault (code 94); the levels 2 and 3 focus on defining fracture location and morphology within more detailed regions and subregions. Correct imaging acquisition, systematic analysis, and interpretation according to the anatomic and surgical relevant structures in the CMF regions are essential for an accurate, reproducible, and comprehensive diagnosis of CMF fractures using that system. Basic principles for radiographic diagnosis are based on conventional plain films, multidetector computed tomography, and magnetic resonance imaging. In this tutorial, the radiological issues according to each level of the classification are described.8 page(s

Health economic impact of the technology “osteosynthesis” on fracture care : an economic analysis for 17 high income countries over the course of 60 years

Objectives: After the inception of the AO Foundation in1958, fracture osteosynthesis (OS) was introduced in Switzerland and in the following 2 to 3 decade globally. OS has revolutionized fracture care. However, there has never been a formal impact evaluation of OS as a medical innovation. It was the aim to estimate the health economic impact of OS in fracture care for three index bones over 60 years in 17 high-income countries. Methods: A modelling approach using a decision tree was applied for this cost comparison study. To do so, a (hypothetical) absence of the OS technology was presumed and OS (intervention) was compared with conservative treatment (CONS; comparator) from a societal perspective. We included fracture patients with femur, tibia and radius fractures (age ,65yr.); for proximal femur fractures elderly patients ($70yr.) were also included. Outcomes were differences between OS and CONS in years of life gained (YLG), direct and indirect costs (2015 Swiss Francs for all modelled years; discount rate 3%). We used data from the Swiss Accident Insurance, OECD and World Bank. From our base case Switzerland, we extrapolated our results to 16 other high-income countries from four continents (Europe, North America, Asia, Australia) and performed sensitivity analyses. Results: In the working age population, CHF 855 bn. (sensitivity analysis: min. CHF 360 bn. to max. CHF 1213 bn.) were saved in direct and indirect costs over 6 decades in 17 countries for femur, tibia and radius fractures. 4.6 million YLG were gained in this age group (2/3 of them before age 65 and included in indirect costs). In the elderly population with proximal femur fractures, CHF 69 bn. were saved in direct costs in addition to 73 million YLG. Conclusions: The health economic impact of OS was substantial over six decades. It resulted important productivity gains and YLG