Cost-Effectiveness Analysis of Motion-Preserving Operations for Wrist Arthritis. Issue 5 (November 2020)

• Record Type: Journal Article
• Authors: Retrouvey, Helene; Sander, Beate; von Schroeder, Herbert P.; Binhammer, Paul; Baltzer, Heather L.
• Is Part Of: Plastic and reconstructive surgery. Volume 146:Issue 5(2020)
• Publication Date: 2020-11
• Subjects: Surgery, Plastic -- Periodicals; 617.95205
• DOI: 10.1097/PRS.0000000000007260
• Languages: English
• ISSNs: 0032-1052

Abstract

Abstract : Background: The authors conducted a cost-effectiveness analysis to answer the question: Which motion-preserving surgical strategy, (1) four-corner fusion, (2) proximal row carpectomy, or (3) total wrist arthroplasty, used for the treatment of wrist osteoarthritis, is the most cost-effective? Methods: A simulation model was created to model a hypothetical cohort of wrist osteoarthritis patients (mean age, 45 years) presenting with painful wrist and having failed conservative management. Three initial surgical treatment strategies—(1) four-corner fusion, (2) proximal row carpectomy, or (3) total wrist arthroplasty—were compared from a hospital perspective. Outcomes included clinical outcomes and cost-effectiveness outcomes (quality-adjusted life-years and cost) over a lifetime. Results: The highest complication rates were seen in the four-corner fusion cohort: 27.1 percent compared to 20.9 percent for total wrist arthroplasty and 17.4 percent for proximal row carpectomy. Secondary surgery was common for all procedures: 87 percent for four-corner fusion, 57 percent for proximal row carpectomy, and 46 percent for total wrist arthroplasty. Proximal row carpectomy generated the highest quality-adjusted life-years (30.5) over the lifetime time horizon, compared to 30.3 quality-adjusted life-years for total wrist arthroplasty and 30.2 quality-adjusted life-years for four-corner fusion. Proximal row carpectomy was the least costly; the mean expected lifetime cost for patients starting with proximal row carpectomy was $6003, compared to $11, 033 for total wrist arthroplasty and $13, 632 for four-corner fusion. Conclusions: The authors' analysis suggests that proximal row carpectomy was the most cost-effective strategy, regardless of patient and parameter level uncertainties. These are important findings for policy makers and clinicians working within a universal health care system. Abstract : Supplemental Digital Content is available in the text.