Albright Rachel H, Waverly Brett J, Klein Erin, Weil Lowell, Weil Lowell S, Fleischer Adam E
Podiatric Medicine & Surgery PGY-3 Resident, Advocate Illinois Masonic Medical Center, Advocate Illinois Masonic Medical Center/Wm. M Scholl College of Podiatric Medicine, Chicago, IL.
Fellowship Trained Foot and Ankle Surgeon, Orthopedic Specialty Clinic, Fredericksburg, VA.
J Foot Ankle Surg. 2018 Mar-Apr;57(2):332-338. doi: 10.1053/j.jfas.2017.10.019.
Hammertoe deformities are one of the most common foot deformities, affecting up to one third of the general population. Fusion of the joint can be achieved with various devices, with the current focus on percutaneous Kirschner (K)-wire fixation or commercial intramedullary implant devices. The purpose of the present study was to determine whether surgical intervention with percutaneous K-wire fixation versus commercial intramedullary implant is more cost effective for proximal interphalangeal joint arthrodesis in hammertoe surgery. A formal cost-effectiveness analysis using a decision analytic tree model was conducted to investigate the healthcare costs and outcomes associated with either K-wire or commercial intramedullary implant fixation. The outcomes assessed included long-term costs, quality-adjusted life-years (QALYs), and incremental cost per QALY gained. Costs were evaluated from the healthcare system perspective and are expressed in U.S. dollars at a 2017 price base. Our results found that commercial implants were minimally more effective than K-wires but carried significantly higher costs. The total cost for treatment with percutaneous K-wire fixation was $5041 with an effectiveness of 0.82 QALY compared with a commercial implant cost of $6059 with an effectiveness of 0.83 QALY. The incremental cost-effectiveness ratio of commercial implants was $146,667. With an incremental cost-effectiveness ratio of >$50,000, commercial implants failed to justify their proposed benefits to outweigh their cost compared to percutaneous K-wire fixation. In conclusion, percutaneous K-wire fixation would be preferred for arthrodesis of the proximal interphalangeal joint for hammertoes from a healthcare system perspective.
槌状趾畸形是最常见的足部畸形之一，影响着多达三分之一的普通人群。关节融合可以通过各种器械实现，目前的重点是经皮克氏（K）针固定或商用髓内植入器械。本研究的目的是确定在槌状趾手术中，经皮K针固定与商用髓内植入物的手术干预对于近端指间关节融合术而言，哪种更具成本效益。使用决策分析树模型进行了正式的成本效益分析，以研究与K针或商用髓内植入物固定相关的医疗成本和结果。评估的结果包括长期成本、质量调整生命年（QALY）以及每获得一个QALY的增量成本。成本从医疗保健系统的角度进行评估，并以2017年价格基准的美元表示。我们的结果发现，商用植入物仅比K针稍微有效一些，但成本却显著更高。经皮K针固定治疗的总成本为5041美元，有效性为0.82 QALY，而商用植入物成本为6059美元，有效性为0.83 QALY。商用植入物的增量成本效益比为146,667美元。由于增量成本效益比>50,000美元，与经皮K针固定相比，商用植入物无法证明其提议的益处超过成本是合理的。总之，从医疗保健系统的角度来看，经皮K针固定对于槌状趾近端指间关节融合术是更可取的。
