Cost-Effectiveness Analysis of Motion-Preserving Operations for Wrist Arthritis.

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.

• Authors: Helene Retrouvey, Beate Sander, Herbert P von Schroeder, Paul Binhammer, Heather L Baltzer
• Journal: Plastic and reconstructive surgery (Plast Reconstr Surg) Vol. 146 Issue 5 Pg. 588e-598e (11 2020) ISSN: 1529-4242 [Electronic] United States
• PMID: 33141535 (Publication Type: Journal Article)

Topics

• Adult
• Arthrodesis (economics, methods)
• Arthroplasty, Replacement (economics, methods)
• Carpal Bones (surgery)
• Computer Simulation
• Cost-Benefit Analysis
• Female
• Hand Strength (physiology)
• Hospital Costs
• Humans
• Male
• Markov Chains
• Middle Aged
• Models, Economic
• Organ Sparing Treatments (economics, methods)
• Osteoarthritis (economics, surgery)
• Osteotomy (economics, methods)
• Range of Motion, Articular (physiology)
• Treatment Outcome
• Wrist Joint (physiology, surgery)