Cost-effectiveness of surgical treatment of thumb carpometacarpal joint arthritis: a value of information study

Cost Effectiveness and Resource Allocation

Research

David W. Hutton¹  Kevin C. Chung²  Alfred P. Yoon² 

[1] Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA;Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, 2130 Taubman Center, 1500 East Medical Center Drive, 48109-0340, Ann Arbor, Ann Arbor, MI, Michigan, USA;

关键词: Thumb carpometacarpal joint arthritis;    CMC arthritis;    Basal joint arthritis;    Cost-effectiveness analysis;    Value of information analysis;    Expected value of perfect information;   

DOI  :  10.1186/s12962-023-00438-8

 received in 2022-08-24, accepted in 2023-04-10,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundThumb carpometacarpal (CMC) joint arthritis is one of the most prevalent arthritic conditions commonly treated with trapeziectomy alone or trapeziectomy with ligament reconstruction and tendon interposition (LRTI). We evaluate the cost-effectiveness and value of perfect and sample information of trapeziectomy alone, LRTI, and non-operative treatment.MethodsA societal perspective decision tree was modeled. To understand the value of future research in comparing quality-of-life after trapeziectomy, LRTI, and non-operative management we characterized uncertainty by fitting distributions to EQ-5D utility data published from the United Kingdom hand surgery registry. We used Monte Carlo simulation for the probabilistic sensitivity analysis and to evaluate the value of perfect and sample information.ResultsBoth trapeziectomy alone and LRTI were cost-effective compared to non-operative management ($2,540 and $3,511/QALY respectively). Trapeziectomy alone (base case total cost $8,251, QALY 14.08) was dominant compared to LRTI (base case total cost $8,798, QALY 13.34). However, probabilistic sensitivity analysis suggested there is a 12.5% chance LRTI may be preferred at a willingness-to-pay of $50,000/QALY. Sensitivity analysis revealed postoperative utilities are the most influential factors in determining cost-effectiveness. The value of perfect information was approximately $1,503/person. A study evaluating the quality-of-life of 1,000 patients in each arm undergoing trapeziectomy alone or LRTI could provide an expected $1,117 of information value. With approximately 40,000 CMC arthroplasties performed each year in the U.S., the annual value is close to $45 million.ConclusionsTrapeziectomy without LRTI appears to be the most cost-effective procedure in treating late-stage CMC arthritis and should be considered as first-line surgical treatment. There is substantial societal value in conducting additional research to better understand the relative quality-of-life improvements gained from these two common hand surgeries.

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

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Fig. 4