Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792.
Department of Radiology, New York University-Langone Health, New York, NY.
AJR Am J Roentgenol. 2022 Feb;218(2):234-240. doi: 10.2214/AJR.21.26419. Epub 2021 Sep 15.
. Morton neuroma is a common, painful disorder of the foot with multiple treatment options of varying cost and effectiveness. . The aim of this study was to determine the most cost-effective treatment pathway for symptomatic Morton neuromas when conservative management has failed. . An incremental cost-utility analysis was performed comparing a direct to surgical neurectomy strategy with three selective injection strategies in which one or more ultrasound-guided injection therapies was tried first before surgery for patients who did not respond to treatment. The three selective injection strategies were selective steroid injection, selective alcohol injection, and selective steroid/alcohol injection in which both steroid injections and alcohol sclerosing injections were trialed successively before surgical neurectomy. The direct-to-surgery approach was compared with the three different selective injection strategies and with a no-treatment strategy in a decision-analytic model for a hypothetical group of patients with symptomatic Morton neuroma in whom conservative management had failed. Model parameters, including treatment costs, effectiveness, complication rates, and health utility states, were estimated from the literature, reimbursement databases, and expert opinion. The outcome was cost per quality-adjusted life year (QALY) with a time horizon of 3 years. A societal cost perspective was adopted with a willingness-to-pay threshold of $100,000/QALY. Sensitivity analyses for key model parameters were performed. . For the base input values, the steroid/alcohol selective injection strategy was dominant and yielded an incremental cost-effectiveness ratio of $4401.61/QALY compared with no treatment. The probabilistic sensitivity analysis supported this strategy in 74% of 10,000 simulated trials. Results were robust with low sensitivity to most input parameters. However, when the probability of successful alcohol injection treatment dropped below 40%, the steroid selective injection strategy became most cost-effective. . A trial of ultrasound-guided injection therapies for Morton neuroma is a cost-effective strategy compared with proceeding directly to surgical neurectomy. . Ultrasound-guided injection therapies are indicated as first-line treatment of patients with symptomatic Morton neuromas when conservative management fails.
. 莫顿神经瘤是一种常见的足部疼痛性疾病，有多种治疗方法，费用和效果各不相同。. 本研究旨在确定在保守治疗失败后，对于症状性莫顿神经瘤，哪种治疗途径最具成本效益。. 采用增量成本-效用分析，比较了直接手术神经切除术策略与三种选择性注射策略。对于未对治疗产生反应的患者，在手术前首先尝试一种或多种超声引导注射治疗，如果治疗无效，则进行手术。三种选择性注射策略分别为选择性皮质类固醇注射、选择性酒精注射和选择性皮质类固醇/酒精注射，其中在进行手术神经切除术之前，先尝试皮质类固醇注射和酒精硬化注射。直接手术方法与三种不同的选择性注射策略以及不治疗策略进行比较，假设一组症状性莫顿神经瘤患者保守治疗失败，采用决策分析模型进行分析。模型参数包括治疗费用、疗效、并发症发生率和健康效用状态，根据文献、报销数据库和专家意见进行估计。结果为每质量调整生命年（QALY）的成本，时间范围为 3 年。采用社会成本视角，愿意支付的阈值为 10 万美元/QALY。对关键模型参数进行了敏感性分析。. 对于基础输入值，皮质类固醇/酒精选择性注射策略具有优势，与不治疗相比，增量成本效果比为 4401.61 美元/QALY。概率敏感性分析在 10000 次模拟试验中的 74%次试验中支持该策略。结果具有稳健性，对大多数输入参数的敏感性较低。然而，当酒精注射治疗成功的概率低于 40%时，皮质类固醇选择性注射策略成为最具成本效益的策略。. 与直接手术神经切除术相比，超声引导注射疗法治疗莫顿神经瘤是一种具有成本效益的策略。. 对于症状性莫顿神经瘤患者，在保守治疗失败后，超声引导注射疗法是一线治疗方法。
