Cost effectiveness of wrist fluoroscopy and arthrography in the evaluation of obscure wrist pain.

The cost effectiveness of wrist fluoroscopy and arthrography was evaluated in patients with obscure wrist pain. Dynamic fluoroscopy was performed in 91 cases and was positive in 54 (59%). Radiocarpal arthrography was performed in 60 of these cases in which further information was desired. Arthrography increased the diagnostic yield to 62 of 91 cases (68%). Diagnoses included ligament and cartilage tears, and dynamic intercarpal instability. The cost per positive examination for fluoroscopy, based on total cost for fluoroscopy in 91 patients divided by number of positive cases, is $126. The cost per positive examination by arthrography alone is $377. When arthrography is done only when fluoroscopy is equivocal or negative, the cost per positive examination (fluoroscopy plus arthrography) drops to $280. Wrist arthrography is only cost effective if done after dynamic fluoroscopy fails to answer the clinical questions. When done together in this setting, the two procedures are most cost effective than arthrography alone. Based on current costs, conservative treatment of carpal instability costs about $1,500, and surgical therapy costs about $4,000. Thus, fluoroscopy and arthrography may further reduce the cost of management of obscure wrist pain by identifying those patients who would not benefit from surgical exploration.