{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T14:47:14Z","timestamp":1780325234216,"version":"3.54.1"},"reference-count":36,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T00:00:00Z","timestamp":1769731200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001826","name":"ZonMw","doi-asserted-by":"publisher","award":["80-83700-98-16501"],"award-info":[{"award-number":["80-83700-98-16501"]}],"id":[{"id":"10.13039\/501100001826","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The number of surgical procedures for distal radius fractures in the elderly has increased, even though most studies show little or no benefit over cast treatment. While medical costs of surgical treatment are higher than those of cast treatment, surgery may enable faster recovery and help patients maintain independence, potentially reducing their use of other healthcare resources and informal care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We evaluated whether cast treatment is cost-effective compared to surgery for patients aged 65 years or older with substantially displaced intra-articular distal radius fractures. A multicentre randomized controlled non-inferiority trial with an economic evaluation in 19 hospitals in the Netherlands. Participants completed (cost) questionnaires at baseline, 3, 6, 9 and 12 months after trauma. A total of 138 patients were randomized between cast treatment and surgery. Health-related quality of life was measured with the EQ-5D-3L; wrist function was measured with the Patient Rated Wrist Evaluation (PRWE). Costs were assessed from a societal perspective, including intervention costs, healthcare use, informal care, unpaid productivity losses, and patients\u2019 own expenses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The estimated difference in total societal costs was -\u20ac81 (95%CI -\u20ac3936 to \u20ac3773) in favour of cast treatment compared with surgical treatment. Compared with cast treatment, surgery resulted in improved wrist function (PRWE: \u22125.5; 95% CI: \u221210 to \u22120.7) and slightly higher QALYs (+0.039; 95%CI 0.012 to 0.066), equivalent to 14 days in perfect health. The incremental cost-effectiveness ratio was \u20ac15 per point improvement in PRWE and \u20ac2070 per QALY gained. Cast treatment\u2019s probability of cost-effectiveness was low for all values of willingness to pay.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Although cast treatment had lower direct costs, these were offset by higher informal and secondary care costs. Surgical treatment offered clinically relevant short-term benefits. From a societal perspective, surgery appears to be the more favorable option for elderly patients with displaced distal radius fractures.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0339489","type":"journal-article","created":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T18:45:10Z","timestamp":1769798710000},"page":"e0339489","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Cost-effectiveness of cast treatment vs. surgery in elderly patients with substantially displaced intra-articular distal radius fractures: A trial-based economic evaluation"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6600-3330","authenticated-orcid":true,"given":"Dirk P.","family":"ter Meulen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johanna M.","family":"van Dongen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ydo V.","family":"Kleinlugtenbelt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerald A.","family":"Kraan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3942-0304","authenticated-orcid":true,"given":"J. Carel","family":"Goslings","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niels W.L.","family":"Schep","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nienke W.","family":"Willigenburg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rudolf W.","family":"Poolman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"On behalf of the DART study group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,1,30]]},"reference":[{"issue":"8","key":"pone.0339489.ref001","doi-asserted-by":"crossref","first-page":"1282","DOI":"10.1016\/j.jhsa.2011.05.017","article-title":"Current and future national costs to medicare for the treatment of distal radius fracture in the elderly","volume":"36","author":"MJ Shauver","year":"2011","journal-title":"J Hand Surg Am"},{"issue":"7","key":"pone.0339489.ref002","doi-asserted-by":"crossref","first-page":"1280","DOI":"10.1016\/j.jhsa.2014.04.018","article-title":"Complications associated with operative versus nonsurgical treatment of distal radius fractures in patients aged 65 years and older","volume":"39","author":"K Lutz","year":"2014","journal-title":"J Hand Surg Am"},{"key":"pone.0339489.ref003","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1177\/2151458511426874","article-title":"Aspects of current management of distal radius fractures in the elderly individuals","volume":"2","author":"R Arora","year":"2011","journal-title":"Geriatr Orthop Surg Rehabil"},{"issue":"8","key":"pone.0339489.ref004","doi-asserted-by":"crossref","first-page":"1868","DOI":"10.2106\/JBJS.H.01297","article-title":"Trends in the United States in the treatment of distal radial fractures in the elderly","volume":"91","author":"KC Chung","year":"2009","journal-title":"J Bone Joint Surg Am"},{"issue":"7","key":"pone.0339489.ref005","doi-asserted-by":"crossref","first-page":"963","DOI":"10.1302\/0301-620X.96B7.33149","article-title":"The operative treatment of fractures of the distal radius is increasing: results from a nationwide Swedish study","author":"C Mellstrand-Navarro","year":"2014","journal-title":"Bone Joint J"},{"issue":"23","key":"pone.0339489.ref006","doi-asserted-by":"crossref","first-page":"2146","DOI":"10.2106\/JBJS.J.01597","article-title":"A prospective randomized trial comparing nonoperative treatment with volar locking plate fixation for displaced and unstable distal radial fractures in patients sixty-five years of age and older","volume":"93","author":"R Arora","year":"2011","journal-title":"J Bone Joint Surg Am"},{"issue":"46","key":"pone.0339489.ref007","first-page":"779","article-title":"The treatment of displaced intra-articular distal radius fractures in elderly patients","volume":"111","author":"ORCHID Study Group","year":"2014","journal-title":"Dtsch Arztebl Int"},{"issue":"6","key":"pone.0339489.ref008","article-title":"Comparison of 24-Month Outcomes After Treatment for Distal Radius Fracture: The WRIST Randomized Clinical Trial","volume":"4","author":"WRIST Group","year":"2021","journal-title":"JAMA Netw Open"},{"issue":"6","key":"pone.0339489.ref009","doi-asserted-by":"crossref","DOI":"10.1097\/PRS.0000000000006829","article-title":"The Wrist and Radius Injury Surgical Trial: 12-Month Outcomes from a Multicenter International Randomized Clinical Trial","volume":"145","author":"KC Chung","year":"2020","journal-title":"Plast Reconstr Surg"},{"issue":"3","key":"pone.0339489.ref010","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1001\/jamasurg.2020.5672","article-title":"Surgical Plating vs Closed Reduction for Fractures in the Distal Radius in Older Patients: A Randomized Clinical Trial","volume":"156","author":"Combined Randomised and Observational Study of Surgery for Fractures in the Distal Radius in the Elderly (CROSSFIRE) Study Group","year":"2021","journal-title":"JAMA Surg"},{"issue":"2","key":"pone.0339489.ref011","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1302\/0301-620X.103B2.BJJ-2020-0192.R2","article-title":"Cast immobilization is non-inferior to volar locking plates in relation to QuickDASH after one year in patients aged 65 years and older: a randomized controlled trial of displaced distal radius fractures","author":"SS Hassellund","year":"2021","journal-title":"Bone Joint J"},{"issue":"7","key":"pone.0339489.ref012","doi-asserted-by":"crossref","first-page":"609","DOI":"10.2106\/JBJS.19.00597","article-title":"Volar Plate Fixation in Adults with a Displaced Extra-Articular Distal Radial Fracture Is Cost-Effective","volume":"102","author":"VIPER Trial Collaborators","year":"2020","journal-title":"J Bone Joint Surg Am"},{"issue":"21","key":"pone.0339489.ref013","doi-asserted-by":"crossref","first-page":"1970","DOI":"10.2106\/JBJS.20.01345","article-title":"Cost Analysis of Volar Plate Fixation Versus Plaster Cast Immobilization for Intra-Articular Distal Radial Fractures","volume":"103","author":"VIPAR Collaborators","year":"2021","journal-title":"J Bone Joint Surg Am"},{"issue":"12","key":"pone.0339489.ref014","doi-asserted-by":"crossref","first-page":"1027","DOI":"10.1302\/2633-1462.212.BJO-2021-0108.R1","article-title":"Surgical treatment is not cost-effective compared to nonoperative treatment for displaced distal radius fractures in patients 65 years and over","volume":"2","author":"S Hassellund","year":"2021","journal-title":"Bone Jt Open"},{"issue":"12","key":"pone.0339489.ref015","doi-asserted-by":"crossref","first-page":"3311","DOI":"10.1111\/ans.18134","article-title":"Surgical plating versus closed reduction for fractures in the distal radius in older patients: a cost-effectiveness analysis from the hospital perspective","volume":"92","author":"M Howell","year":"2022","journal-title":"ANZ J Surg"},{"issue":"4","key":"pone.0339489.ref016","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2021-051658","article-title":"Effectiveness and cost-effectiveness of surgery versus casting for elderly patients with Displaced intra-Articular type C distal Radius fractures: protocol of a randomised controlled Trial with economic evaluation (the DART study)","volume":"12","author":"DP Ter Meulen","year":"2022","journal-title":"BMJ Open"},{"issue":"3","key":"pone.0339489.ref017","article-title":"Cast Versus Surgery for Displaced Intra-Articular Distal Radius Fractures in the Elderly a Randomized Clinical Noninferiority Trial (the DART Study)","volume":"10","author":"DP Ter Meulen","year":"2025","journal-title":"JB JS Open Access"},{"issue":"1","key":"pone.0339489.ref018","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1302\/2046-3758.71.BJR-2017-0081.R1","article-title":"Are the patient-rated wrist evaluation (PRWE) and the disabilities of the arm, shoulder and hand (DASH) questionnaire used in distal radial fractures truly valid and reliable?","volume":"7","author":"YV Kleinlugtenbelt","year":"2018","journal-title":"Bone Joint Res"},{"issue":"8","key":"pone.0339489.ref019","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1097\/00005131-199811000-00009","article-title":"Patient rating of wrist pain and disability: a reliable and valid measurement tool","volume":"12","author":"JC MacDermid","year":"1998","journal-title":"J Orthop Trauma"},{"issue":"6","key":"pone.0339489.ref020","doi-asserted-by":"crossref","first-page":"908","DOI":"10.2522\/ptj.20140589","article-title":"Structural Validity of the Dutch Version of the Patient-Rated Wrist Evaluation (PRWE-NL) in Patients With Hand and Wrist Injuries","volume":"96","author":"M El Moumni","year":"2016","journal-title":"Phys Ther"},{"issue":"4","key":"pone.0339489.ref021","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1016\/j.jhsa.2012.12.032","article-title":"Minimal clinically important differences of 3 patient-rated outcomes instruments","volume":"38","author":"AA Sorensen","year":"2013","journal-title":"J Hand Surg Am"},{"issue":"5","key":"pone.0339489.ref022","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1177\/1558944717725378","article-title":"Responsiveness of EQ-5D in Patients With a Distal Radius Fracture","volume":"13","author":"J Rundgren","year":"2018","journal-title":"Hand (N Y)"},{"issue":"5","key":"pone.0339489.ref023","doi-asserted-by":"crossref","first-page":"337","DOI":"10.3109\/07853890109002087","article-title":"EQ-5D: a measure of health status from the EuroQol Group","volume":"33","author":"R Rabin","year":"2001","journal-title":"Ann Med"},{"issue":"10","key":"pone.0339489.ref024","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.1002\/hec.1124","article-title":"The Dutch tariff: results and arguments for an effective design for national EQ-5D valuation studies","volume":"15","author":"LM Lamers","year":"2006","journal-title":"Health Econ"},{"key":"pone.0339489.ref025","volume-title":"Methods for the economic evaluation of health care programmes","author":"MF Drummond","year":"2015"},{"issue":"6","key":"pone.0339489.ref026","doi-asserted-by":"crossref","first-page":"1523","DOI":"10.1007\/s11136-004-7713-0","article-title":"Comparison of the minimally important difference for two health state utility measures: EQ-5D and SF-6D","volume":"14","author":"SJ Walters","year":"2005","journal-title":"Qual Life Res"},{"issue":"11","key":"pone.0339489.ref027","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0187477","article-title":"Update of the Dutch manual for costing studies in health care","volume":"12","author":"TA Kanters","year":"2017","journal-title":"PLoS One"},{"issue":"11","key":"pone.0339489.ref028","doi-asserted-by":"crossref","first-page":"1403","DOI":"10.1007\/s40273-023-01301-7","article-title":"Conducting Trial-Based Economic Evaluations Using R: A Tutorial","volume":"41","author":"\u00c2J Ben","year":"2023","journal-title":"Pharmacoeconomics"},{"issue":"4","key":"pone.0339489.ref029","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1002\/sim.4067","article-title":"Multiple imputation using chained equations: Issues and guidance for practice","volume":"30","author":"IR White","year":"2011","journal-title":"Stat Med"},{"issue":"12","key":"pone.0339489.ref030","doi-asserted-by":"crossref","first-page":"2680","DOI":"10.1002\/hec.4603","article-title":"A scoping review of statistical methods for trial-based economic evaluations: The current state of play","volume":"31","author":"M El Alili","year":"2022","journal-title":"Health Econ"},{"issue":"3","key":"pone.0339489.ref031","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1002\/hec.1477","article-title":"Non-parametric methods for cost-effectiveness analysis: the central limit theorem and the bootstrap compared","volume":"19","author":"RM Nixon","year":"2010","journal-title":"Health Econ"},{"issue":"9","key":"pone.0339489.ref032","doi-asserted-by":"crossref","first-page":"787","DOI":"10.2106\/JBJS.18.00693","article-title":"Volar Plate Fixation Versus Plaster Immobilization in Acceptably Reduced Extra-Articular Distal Radial Fractures: A Multicenter Randomized Controlled Trial","volume":"101","author":"VIPER Trial Collaborators","year":"2019","journal-title":"J Bone Joint Surg Am"},{"issue":"21","key":"pone.0339489.ref033","doi-asserted-by":"crossref","first-page":"1963","DOI":"10.2106\/JBJS.20.01344","article-title":"Volar Plate Fixation Versus Cast Immobilization in Acceptably Reduced Intra-Articular Distal Radial Fractures: A Randomized Controlled Trial","volume":"103","author":"CA Selles","year":"2021","journal-title":"J Bone Joint Surg Am"},{"issue":"11","key":"pone.0339489.ref034","doi-asserted-by":"crossref","first-page":"1403","DOI":"10.1007\/s40273-023-01301-7","article-title":"Conducting Trial-Based Economic Evaluations Using R: A Tutorial","volume":"41","author":"\u00c2J Ben","year":"2023","journal-title":"Pharmacoeconomics"},{"issue":"4","key":"pone.0339489.ref035","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1111\/j.1524-4733.2008.00489.x","article-title":"Transferability of economic evaluations across jurisdictions: ISPOR Good Research Practices Task Force report","volume":"12","author":"M Drummond","year":"2009","journal-title":"Value Health"},{"issue":"6","key":"pone.0339489.ref036","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1097\/JOM.0000000000000165","article-title":"Trial-based economic evaluations in occupational health: principles, methods, and recommendations","volume":"56","author":"JM van Dongen","year":"2014","journal-title":"J Occup Environ Med"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0339489","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T18:45:16Z","timestamp":1769798716000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0339489"}},"subtitle":[],"editor":[{"given":"Sina","family":"Dindarian","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,1,30]]},"references-count":36,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1,30]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0339489","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,30]]}}}