Department of Orthopaedics, University of Utah, Salt Lake City, UT.
Department of Economics, University of Utah, Salt Lake City, UT.
J Hand Surg Am. 2023 Jan;48(1):9-18. doi: 10.1016/j.jhsa.2022.09.002. Epub 2022 Nov 17.
Dorsal wrist ganglions are treated commonly with aspiration, or open or arthroscopic excision in operating room (OR) or procedure room (PR) settings. As it remains unclear which treatment strategy is most cost-effective in yielding cyst resolution, our purpose was to perform a formal cost-minimization analysis from the societal perspective in this context.
A microsimulation decision analytic model evaluating 5 treatment strategies for dorsal wrist ganglions was developed, ending in either resolution or a single failed open revision surgical excision. Strategies included immediate open excision in the OR, immediate open excision in the PR, immediate arthroscopic excision in the OR, or 1 or 2 aspirations before each of the surgical options. Recurrence and complications rates were pooled from the literature for each treatment type. One-way sensitivity and threshold analyses were performed.
The most cost-minimal strategy was 2 aspiration attempts before open surgical excision in the PR setting ($1,603 ± 1,595 per resolved case), followed by 2 aspirations before open excision in the OR ($1,969 ± 2,165 per resolved case). Immediate arthroscopic excision was the costliest strategy ($6,539 ± 264 per resolved case). Single aspiration preoperatively was more cost-minimal than any form of immediate surgery ($2,918 ± 306 and $4,188 ± 306 per resolved case performed in the PR and OR, respectively).
From the societal perspective, performing 2 aspirations before surgical excision in the PR setting was the most cost-minimal treatment strategy, although in reference to surgeons who do not perform this procedure in the PR setting, open excision in the OR was nearly as cost-effective. As patient preferences may preclude routinely performing 2 aspirations, performing at least 1 aspiration before surgical excision improves the cost-effectiveness of dorsal wrist ganglions treatment.
TYPE OF STUDY/LEVEL OF EVIDENCE: Economic Decision Analysis II.
腕背腱鞘囊肿通常采用抽吸、手术室（OR）或治疗室（PR）开放式或关节镜下切除进行治疗。由于尚不清楚哪种治疗策略在获得囊肿消退方面最具成本效益，我们的目的是在这种情况下从社会角度进行正式的成本最小化分析。
开发了一个评估 5 种腕背腱鞘囊肿治疗策略的微观模拟决策分析模型，最终结果为解决或单次开放式修正手术切除失败。策略包括 OR 中的即时开放式切除、PR 中的即时开放式切除、OR 中的即时关节镜下切除，或在每个手术选项之前进行 1 或 2 次抽吸。每种治疗类型的复发和并发症发生率均从文献中汇总。进行了单因素敏感性和阈值分析。
成本最小化的策略是在 PR 环境下进行 2 次抽吸尝试，然后再进行开放式手术切除（每例解决病例的费用为 1603 美元±1595 美元），其次是在 OR 中进行 2 次抽吸尝试，然后再进行开放式切除（每例解决病例的费用为 1969 美元±2165 美元）。即时关节镜下切除是最昂贵的策略（每例解决病例的费用为 6539 美元±264 美元）。术前单次抽吸比任何形式的即时手术都更具成本效益（在 PR 和 OR 中分别进行的每例解决病例的费用为 2918 美元±306 美元和 4188 美元±306 美元）。
从社会角度来看，在 PR 环境下进行手术切除前进行 2 次抽吸是最具成本效益的治疗策略，尽管对于不在 PR 环境下进行此操作的外科医生来说，OR 中的开放式切除几乎同样具有成本效益。由于患者的偏好可能排除常规进行 2 次抽吸，因此在手术切除前进行至少 1 次抽吸可以提高腕背腱鞘囊肿治疗的成本效益。
研究类型/证据水平：经济决策分析 II。
