Fecha de publicación: -- Fuente: PubMed "rice" J Shoulder Elbow Surg. 2026 Nov 9:S1058-2746(26)00704-4. doi: 10.1016/j.jse.2026.11.029. Online ahead of print.ABSTRACTBACKGROUND: Mason type III and IV comminuted radial head fractures present a treatment dilemma between open reduction internal fixation (ORIF) and radial head arthroplasty (RHA). Functional outcomes, implant complications, and later treatment options vary across patients. We evaluated the cost-effectiveness of these strategies under explicit clinical and economic assumptions.METHODS: We constructed a 5-state Markov cost-utility model for a Mason III/IV fracture, using a 10-year horizon, 3% annual discounting, and US Medicare payment benchmarks. An illustrative base case used good outcome probabilities of 15/23 for ORIF and 20/22 for RHA. Time-zero allocation of follow-up outcomes, state utilities, and later transitions were assumptions. Index costs used verified 2025 Physician Fee Schedule and Hospital Outpatient Prospective Payment System rates. We performed one-way, probabilistic (10,000 iterations), breakeven, and structural sensitivity analyses.RESULTS: ORIF accrued $16,795 and 7.045 quality-adjusted life years (QALYs); RHA accrued $19,242 and 7.299 QALYs. RHA's incremental cost-effectiveness ratio (ICER) was $9,627/QALY, with incremental net monetary benefit of $22,970 at $100,000/QALY. Allocating outcomes at year 2 yielded $14,880/QALY, assuming zero unmeasured early differential secondary-care costs. RHA was cost-effective in 94.6% of probabilistic iterations at $100,000/QALY. The breakeven ORIF good outcome probability was 85.7%. When initial clinical outcomes were equal, ORIF was less costly with equal QALYs.CONCLUSION: The illustrative base case favored RHA under the assumed functional difference and utilities. Higher ORIF success, early convergence, or a treatment-specific utility burden could remove that preference. These conditional findings require validation with contemporary fracture-specific utility and treatment-pathway data.LEVEL OF EVIDENCE: Level III; Economic and Decision Analysis.PMID:43003380 | DOI:10.1016/j.jse.2026.11.029