Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Am J Sports Med. 2024 Jul;52(9):2319-2330. doi: 10.1177/03635465241255147. Epub 2024 Jun 20.
Nonoperative management versus early reconstruction for partial tears of the medial ulnar collateral ligament (MUCL) remains controversial, with the most common treatment options for partial tears consisting of rest, rehabilitation, platelet-rich plasma (PRP), and/or surgical intervention. However, whether the improved outcomes reported for treatments such as MUCL reconstruction (UCLR) or nonoperative management with a series of PRP injections justifies their increased upfront costs remains unknown.
To compare the cost-effectiveness of an initial trial of physical therapy alone, an initial trial of physical therapy plus a series of PRP injections, and early UCLR to determine the preferred cost-effective treatment strategy for young, high-level baseball pitchers with partial tears of the MUCL and with aspirations to continue play at the next level (ie, collegiate and/or professional).
Economic and decision analysis; Level of evidence, 2.
A Markov chain Monte Carlo probabilistic model was developed to evaluate the outcomes and costs of 1000 young, high-level, simulated pitchers undergoing nonoperative management with and without PRP versus early UCLR for partial MUCL tears. Utility values, return to play rates, and transition probabilities were derived from the published literature. Costs were determined based on the typical patient undergoing each treatment strategy at the authors' institution. Outcome measures included costs, acquired playing years (PYs), and the incremental cost-effectiveness ratio (ICER).
The mean total costs resulting from nonoperative management without PRP, nonoperative management with PRP, and early UCLR were $22,520, $24,800, and $43,992, respectively. On average, early UCLR produced an additional 4.0 PYs over the 10-year time horizon relative to nonoperative management, resulting in an ICER of $5395/PY, which falls well below the $50,000 willingness-to-pay threshold. Overall, early UCLR was determined to be the preferred cost-effective strategy in 77.5% of pitchers included in the microsimulation model, with nonoperative management with PRP determined to be the preferred strategy in 15% of pitchers and nonoperative management alone in 7.5% of pitchers.
Despite increased upfront costs, UCLR is a more cost-effective treatment option for partial tears of the MUCL than an initial trial of nonoperative management for most high-level baseball pitchers.
对于部分内侧尺侧副韧带（MUCL）撕裂，非手术治疗与早期重建仍存在争议，部分撕裂的常见治疗选择包括休息、康复、富含血小板的血浆（PRP）和/或手术干预。然而，对于 MUCL 重建（UCLR）或一系列 PRP 注射的非手术治疗等治疗方法报告的改善结果是否证明其增加的前期成本是合理的，目前尚不清楚。
比较单独物理治疗的初始试验、单独物理治疗加一系列 PRP 注射的初始试验以及早期 UCLR 的成本效益，以确定对于有继续在更高水平（即大学和/或职业）比赛意愿的年轻高水平棒球投手，哪种治疗策略更具成本效益，用于治疗部分 MUCL 撕裂。
经济和决策分析；证据水平，2 级。
开发了一个马尔可夫链蒙特卡罗概率模型，以评估 1000 名接受非手术治疗且不接受 PRP 治疗与早期 UCLR 的年轻高水平模拟投手的结果和成本，用于治疗部分 MUCL 撕裂。效用值、回归比赛率和转移概率来自已发表的文献。成本根据每位患者在作者所在机构接受每种治疗策略的情况确定。结果包括成本、获得的比赛年数（PYs）和增量成本效益比（ICER）。
非手术治疗且不接受 PRP、非手术治疗且接受 PRP 和早期 UCLR 的平均总费用分别为 22520 美元、24800 美元和 43992 美元。平均而言，与非手术治疗相比，早期 UCLR 在 10 年时间内可额外增加 4.0 个 PY，导致 ICER 为 5395 美元/PY，远低于 50000 美元的支付意愿阈值。总体而言，早期 UCLR 在纳入微模拟模型的 77.5%的投手中被确定为更具成本效益的策略，在接受 PRP 治疗的非手术治疗中被确定为 15%的投手中的首选策略，而在单独接受非手术治疗的投手中则为 7.5%。
尽管前期成本增加，但对于大多数高水平棒球投手而言，与非手术治疗的初始尝试相比，UCLR 是治疗 MUCL 部分撕裂的更具成本效益的治疗选择。
