Purpose
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.
Methods
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.
Results
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).
Conclusions
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.
Key words
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Article info
Publication history
Published online: November 17, 2022
Accepted:
September 6,
2022
Received:
February 13,
2022
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2023 by the American Society for Surgery of the Hand. All rights reserved.
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