Purpose
Knowledge about the costs and benefits of hand surgical interventions is important
for surgeons, payers, and policy makers. Little is known about the cost-effectiveness
of surgery for thumb carpometacarpal osteoarthritis. The objective of this study was to examine patients’ quality of life and economic
costs, with focus on the cost-utility ratio 1 year after surgery for thumb carpometacarpal
osteoarthritis compared with that for continued nonsurgical management.
Methods
Patients with thumb carpometacarpal osteoarthritis indicated for resection arthroplasty
were included in a prospective study. The quality of life (using European Quality
of Life-5 Dimensions-5 Level), direct medical costs, and productivity losses were
assessed up to 1 year after surgery. Baseline data at recruitment and costs sustained
over 1 year before surgery served as a proxy for nonsurgical management. The total
costs to gain 1 extra quality-adjusted life year and the incremental cost-effectiveness
ratio were calculated from a health care system and a societal perspective.
Results
The mean European Quality of Life-5 Dimensions-5 Level value for 151 included patients
improved significantly from 0.69 to 0.88 (after surgery). The productivity loss during
the preoperative period was 47% for 49 working patients, which decreased to 26% 1
year after surgery. The total costs increased from US $20,451 in the preoperative
year to US $24,374 in the postoperative year. This resulted in an incremental cost-effectiveness
ratio of US $25,370 per quality-adjusted life year for surgery compared with that
for simulated nonsurgical management.
Conclusions
The calculated incremental cost-effectiveness ratio was clearly below the suggested
Swiss threshold of US $92,000, indicating that thumb carpometacarpal surgery is a
cost-effective intervention.
Type of study/level of evidence
Economic and Decision Analyses II.
Key words
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References
- Health economic methods: cost-minimization, cost-effectiveness, cost-utility, and cost-benefit evaluations.Crit Care Clin. 2012; 28: 11-24
- Outcomes and direct costs of needle aponeurotomy, collagenase injection, and fasciectomy in the treatment of Dupuytren contracture.J Hand Surg Am. 2019; 44: 919-927
- Cost per episode of care with collagenase Clostridium histolyticum versus fasciectomy for Dupuytren contracture: a real-world claims database analysis.J Hand Surg Glob Online. 2019; 1: 57-64
- Collagenase clostridium histolyticum for the treatment of Dupuytren's contracture: systematic review and economic evaluation.Health Technol Assess. 2015; 19: 1-202
- National prevalence of complications and cost of small joint arthroplasty for hand osteoarthritis and post-traumatic arthritis.J Hand Surg Am. 2020; 45: 553.e1-553.e12
- A 5-year cost-effectiveness analysis of silicone metacarpophalangeal arthroplasty in patients with rheumatoid arthritis.Plast Reconstr Surg. 2015; 136: 305-314
- The health technology assessment of the compulsory accident insurance scheme of hand transplantation in Switzerland.J Hand Surg Eur Vol. 2015; 40: 914-923
- Healthcare costs and loss of productivity in patients with trapeziometacarpal osteoarthritis.J Hand Surg Eur Vol. 2015; 40: 927-934
- Surgery for thumb (trapeziometacarpal joint) osteoarthritis.Cochrane Database Syst Rev. 2015; 2015CD004631
- Basal thumb osteoarthritis surgery improves health state utility irrespective of technique: a study of UK Hand Registry data.J Hand Surg Eur Vol. 2020; 45: 436-442
- Sick leave after surgery for thumb carpometacarpal osteoarthritis: a population-based study.J Hand Surg Am. 2018; 43: 439-447
- Economic impact of hand and wrist injuries: health-care costs and productivity costs in a population-based study.J Bone Joint Surg Am. 2012; 94: e56
- When is it too expensive? Cost-effectiveness thresholds and health care decision-making.Eur J Health Econ. 2019; 20: 175-180
- The NICE cost-effectiveness threshold:what it is and what it means.Pharmacoeconomics. 2008; 26: 733-744
- Cost-effectiveness thresholds: the past, the present and the future.Pharmacoeconomics. 2018; 36: 509-522
- A health opportunity cost threshold for cost-effectiveness analysis in the United States.Ann Intern Med. 2021; 174: 25-32
- Updating cost-effectiveness—the curious resilience of the $50,000-per-QALY threshold.N Engl J Med. 2014; 371: 796-797
- On what basis are medical cost-effectiveness thresholds set? Clashing opinions and an absence of data: a systematic review.Glob Health Action. 2018; 11: 1447828
- Swiss Federal Statistical Office. Gross domestic product per capita.
- Consolidated health economic evaluation reporting standards (CHEERS) statement.Int J Technol Assess. 2013; 29: 117-122
- Comparison of the minimally important difference for two health state utility measures: EQ-5D and SF-6D.Qual Life Res. 2005; 14: 1523-1532
- Surgical treatment of the saddle joint arthrosis.Handchir Mikrochir Plast Chir. 1983; 15: 168-176
- Tendon interposition arthroplasty of the first carpo-metacarpal joint.J Hand Surg Br. 1988; 13: 421-425
- Abductor pollicis longus tendon arthroplasty for treatment of arthrosis in the first carpometacarpal joint.Scand J Plast Reconstr Surg Hand Surg. 1991; 25: 73-77
- Trapeziectomy with suspension-interposition arthroplasty for thumb carpometacarpal osteoarthritis: a randomized controlled trial comparing the use of allograft versus flexor carpi radialis tendon.J Hand Surg Am. 2017; 42: 978-986
- Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L).Qual Life Res. 2011; 20: 1727-1736
- German value set for the EQ-5D-5L.Pharmacoeconomics. 2018; 36: 663-674
- Application and measurement properties of EQ-5D to measure quality of life in patients with upper extremity orthopaedic disorders: a systematic literature review.Arch Orthop Trauma Surg. 2018; 138: 953-961
- Trapeziometacarpal osteoarthritis: staging as a rationale for treatment.Hand Clin. 1987; 3: 455-471
- The validity and reproducibility of a work productivity and activity impairment instrument.Pharmacoeconomics. 1993; 4: 353-365
- Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support.J Biomed Inform. 2009; 42: 377-381
- Pulling cost-effectiveness analysis up by its bootstraps: a non-parametric approach to confidence interval estimation.Health Econ. 1997; 6: 327-340
- Reilly Associates. Health outcomes research.http://www.reillyassociates.net/Index.htmlDate accessed: March 27, 2019
- Determinants of patient satisfaction after surgery or corticosteroid injection for trapeziometacarpal osteoarthritis: results of a prospective cohort study.Arch Orthop Trauma Surg. 2015; 135: 141-147
- No evidence for the effectiveness of a multidisciplinary group based treatment program in patients with osteoarthritis of hands on the short term; results of a randomized controlled trial.Osteoarthritis Cartilage. 2013; 21: 901-910
- Conservative treatment of thumb base osteoarthritis: a systematic review.J Hand Surg Am. 2015; 40: 16-21
- Investigation of the effect of conservative interventions in thumb carpometacarpal osteoarthritis: systematic review and meta-analysis.Disabil Rehabil. 2015; 37: 2025-2043
- Strengthening and stretching for rheumatoid arthritis of the hand (SARAH). A randomised controlled trial and economic evaluation.Health Technol Assess. 2015; 19: 1-222
- Cost-utility analysis of arthroscopic rotator cuff repair: a prospective health economic study using real-world data.Arthrosc Sports Med Rehabil. 2020; 2: e193-e205
- Cost-utility analysis of total shoulder arthroplasty: a prospective health economic study using real-world data.J Shoulder Elbow Surg. 2021; 30: 1998-2006
- A cost-effectiveness analysis of corticosteroid injections and open surgical release for trigger finger.J Hand Surg Am. 2020; 45: 597-609
- Direct, indirect and intangible costs of acute hand and wrist injuries: a systematic review.Injury. 2016; 47: 2614-2626
- Suture suspension arthroplasty for the treatment of thumb carpometacarpal arthritis.J Hand Surg Am. 2019; 44: 296-303
- Outcomes of cementless joint prosthesis versus tendon interposition for trapeziometacarpal osteoarthritis: a prospective study.J Hand Surg Eur Vol. 2019; 44: 151-158
- Prognostic factors for return to work and resumption of other daily activities after traumatic hand injury.J Hand Surg Eur Vol. 2019; 44: 203-207
Article info
Publication history
Published online: March 25, 2022
Accepted:
January 6,
2022
Received:
November 19,
2020
Footnotes
C.G. received grants from Mäxi Foundation and the Bank Vontobel Charitable Foundation. K.E. received grants from Mäxi Foundation, Bank Vontobel Charitable Foundation and Winterthur Network of Health Economics.
Identification
Copyright
© 2022 by the American Society for Surgery of the Hand. All rights reserved.
