Cost-Effectiveness Analysis of the Ottawa Ankle Rules, ,

Study objective: To conduct an incremental cost-effectiveness analysis of implementation of the Ottawa Ankle Rules in emergency departments in the United States and Canada. Design: A decision analytic approach to technology assessment. Clinical decision rules that allow physicians to be more selective in their use of radiography were compared with current practice in a decision analytic model. Setting: A university hospital adult ED. Participants: ED physicians instructed in the use of the Ottawa Ankle Rules for adult patients with ankle injury. Results: Radiography, waiting time, lost productivity, and medicolegal costs were calculated. In the United States, the savings varied between US$614,226 and US$3,145,910 per 100,000 patients, depending on the charge rate for radiography. In Ontario, Canada, the total savings were CAN$730,145 per 100,000 patients. One- and two-way sensitivity analyses that varied the rate of missed fractures, cost of radiography, probability of lawsuits, and cost of lawsuits did not change the results substantially. Conclusion: Implementation of the Ottawa Ankle Rules would result in significant savings of health care dollars despite the cost of missed fractures including litigation costs. [Anis AH, Stiell IG, Stewart DG, Laupacis A: Cost-effectiveness analysis of the Ottawa Ankle Rules. Ann Emerg Med October 1995;26:422-428.]