Yoon Alfred P, Hutton David W, Chung Kevin C
Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, 2130 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, Ann Arbor, MI, Michigan, 48109-0340, USA.
Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA.
Cost Eff Resour Alloc. 2023 May 1;21(1):28. doi: 10.1186/s12962-023-00438-8.
Thumb carpometacarpal (CMC) joint arthritis is one of the most prevalent arthritic conditions commonly treated with trapeziectomy alone or trapeziectomy with ligament reconstruction and tendon interposition (LRTI). We evaluate the cost-effectiveness and value of perfect and sample information of trapeziectomy alone, LRTI, and non-operative treatment.
A societal perspective decision tree was modeled. To understand the value of future research in comparing quality-of-life after trapeziectomy, LRTI, and non-operative management we characterized uncertainty by fitting distributions to EQ-5D utility data published from the United Kingdom hand surgery registry. We used Monte Carlo simulation for the probabilistic sensitivity analysis and to evaluate the value of perfect and sample information.
Both trapeziectomy alone and LRTI were cost-effective compared to non-operative management ($2,540 and $3,511/QALY respectively). Trapeziectomy alone (base case total cost $8,251, QALY 14.08) was dominant compared to LRTI (base case total cost $8,798, QALY 13.34). However, probabilistic sensitivity analysis suggested there is a 12.5% chance LRTI may be preferred at a willingness-to-pay of $50,000/QALY. Sensitivity analysis revealed postoperative utilities are the most influential factors in determining cost-effectiveness. The value of perfect information was approximately $1,503/person. A study evaluating the quality-of-life of 1,000 patients in each arm undergoing trapeziectomy alone or LRTI could provide an expected $1,117 of information value. With approximately 40,000 CMC arthroplasties performed each year in the U.S., the annual value is close to $45 million.
Trapeziectomy without LRTI appears to be the most cost-effective procedure in treating late-stage CMC arthritis and should be considered as first-line surgical treatment. There is substantial societal value in conducting additional research to better understand the relative quality-of-life improvements gained from these two common hand surgeries.
拇指腕掌关节（CMC）关节炎是最常见的关节炎病症之一，通常采用单纯大多角骨切除术或大多角骨切除术联合韧带重建和肌腱植入术（LRTI）进行治疗。我们评估了单纯大多角骨切除术、LRTI和非手术治疗的成本效益以及完美和样本信息的价值。
构建了一个基于社会视角的决策树模型。为了解未来在比较大多角骨切除术、LRTI和非手术治疗后的生活质量方面研究的价值，我们通过将分布拟合到英国手部手术登记处公布的EQ-5D效用数据来描述不确定性。我们使用蒙特卡罗模拟进行概率敏感性分析，并评估完美和样本信息的价值。
与非手术治疗相比，单纯大多角骨切除术和LRTI均具有成本效益（分别为每质量调整生命年2540美元和3511美元）。单纯大多角骨切除术（基础病例总成本8251美元，质量调整生命年14.08）相对于LRTI（基础病例总成本8798美元，质量调整生命年13.34）具有优势。然而，概率敏感性分析表明，在支付意愿为每质量调整生命年50000美元时，LRTI可能更受青睐的概率为12.5%。敏感性分析显示，术后效用是决定成本效益的最有影响因素。完美信息的价值约为每人1503美元。一项评估每组1000例接受单纯大多角骨切除术或LRTI的患者生活质量的研究可提供约1117美元的信息价值。在美国，每年约进行40000例CMC关节成形术，每年的价值接近4500万美元。
不进行LRTI的大多角骨切除术似乎是治疗晚期CMC关节炎最具成本效益的手术，应被视为一线手术治疗方法。开展更多研究以更好地了解这两种常见手部手术在改善生活质量方面的相对获益具有重大的社会价值。
