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Cost-Effectiveness Analysis of Motion-Preserving Operations for Wrist Arthritis
- Source :
- Plastic & Reconstructive Surgery. 146:588e-598e
- Publication Year :
- 2020
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2020.
-
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.
- Subjects :
- Adult
Male
Wrist Joint
medicine.medical_specialty
Surgical strategy
Cost-Benefit Analysis
Arthrodesis
030230 surgery
Wrist
03 medical and health sciences
0302 clinical medicine
Total wrist arthroplasty
Osteoarthritis
medicine
Humans
Computer Simulation
Arthroplasty, Replacement
Hospital Costs
Range of Motion, Articular
Carpal Bones
Wrist arthritis
Hand Strength
business.industry
Mean age
Cost-effectiveness analysis
Middle Aged
medicine.disease
Markov Chains
Osteotomy
Surgery
Wrist osteoarthritis
Models, Economic
Treatment Outcome
medicine.anatomical_structure
030220 oncology & carcinogenesis
Universal health care
Female
business
Organ Sparing Treatments
Subjects
Details
- ISSN :
- 00321052
- Volume :
- 146
- Database :
- OpenAIRE
- Journal :
- Plastic & Reconstructive Surgery
- Accession number :
- edsair.doi.dedup.....1f708ada4da3e3781801e71cc2556420