Kerrigan Carolyn L, Stanwix Matthew G
Section of Plastic Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH 03756, USA.
J Hand Surg Am. 2009 Jul-Aug;34(6):997-1005. doi: 10.1016/j.jhsa.2009.02.029.
Critics of U.S. health care cite both underuse and overuse of resources. With more than one third of Americans paying for medical care out of pocket, optimizing the cost-benefit ratio of care is a high priority. Clinical trials have established the success of the different treatment options for patients who present with trigger finger. The economic impact of these differing strategies has not been established. The aim of this study was to perform a cost-minimization analysis to identify the least costly strategy for effective treatment of trigger finger using existing evidence in the literature.
Five strategies for the treatment of trigger finger were identified: (1) a steroid injection followed by surgical release for failure or recurrence, (2) a steroid injection followed by a second injection for failures or recurrence, followed by definitive surgery if needed, (3) 3 steroid injections before definitive surgery if needed, (4) surgical release, and (5) percutaneous release with definitive open surgery if needed. To reflect the costs, we used 2 sources of data: our institution's billing charges to private payers and our institution's reimbursements from Medicare. A literature review identified median success rates of the different treatment strategies. We conducted a series of analyses to evaluate the effect of varying individual costs and success rates.
The second strategy is the least costly treatment of those considered in this study. The most costly treatment, surgical release, costs between 248% and 340% more than the second strategy. For surgical or percutaneous release to cost less than the second strategy, the surgical billing charge would need to be lower than $742 for private payers or less than $305 of Medicare reimbursement.
Trigger finger is a common problem with many acceptable treatment algorithms. Management of trigger finger with 2 steroid injections before surgery is the least costly treatment strategy.
TYPE OF STUDY/LEVEL OF EVIDENCE: Decision Analysis II.
美国医疗保健的批评者指出资源利用不足和过度利用的问题。超过三分之一的美国人自掏腰包支付医疗费用，因此优化医疗成本效益比是当务之急。临床试验已证实针对扳机指患者的不同治疗方案的有效性。但这些不同策略的经济影响尚未明确。本研究旨在进行成本最小化分析，以利用文献中的现有证据确定治疗扳机指的成本最低的有效策略。
确定了治疗扳机指的五种策略：（1）注射类固醇，若失败或复发则进行手术松解；（2）注射类固醇，若失败或复发则再次注射，必要时进行最终手术；（3）必要时在最终手术前注射3次类固醇；（4）手术松解；（5）经皮松解，必要时进行确定性开放手术。为反映成本，我们使用了两个数据来源：我们机构向私人支付者收取的费用以及我们机构从医疗保险获得的报销。文献综述确定了不同治疗策略的中位成功率。我们进行了一系列分析，以评估个体成本和成功率变化的影响。
第二种策略是本研究中考虑的治疗方法中成本最低的。成本最高的治疗方法，即手术松解，比第二种策略的成本高出248%至340%。要使手术或经皮松解的成本低于第二种策略，对于私人支付者，手术计费需低于742美元，对于医疗保险报销则需低于305美元。
扳机指是一个常见问题，有多种可接受的治疗方案。手术前注射2次类固醇治疗扳机指是成本最低的治疗策略。
研究类型/证据水平：决策分析II。
