Cost-Effectiveness Analysis Comparing Proximal Row Carpectomy and Four-Corner Arthrodesis

Yoo, Minkyoung; Nelson, Richard E.; Illing, Damian; Martin, Brook I.; Tyser, Andrew R.; Kazmers, Nikolas H.

doi:10.2106/jbjs.oa.19.00080

Cited by 9 publications

(4 citation statements)

References 53 publications

(53 reference statements)

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“…In this regard, the sequence of chondral destruction caused by SLAC and SNAC wrist has been previously described in four stages: these areas are generally quite similar within these two degenerative wrist diseases [ 26 ]. While four-corner arthrodesis is a widespread surgery used for these two indications, proximal row carpectomy renders another more cost-effective and less surgically demanding surgical technique [ 26 , 27 ]. However, predicted loss of motion and subsequent OA of the more stressed joints are well-known drawbacks of these two surgical methods [ 24 , 26 ].…”

Section: Discussionmentioning

confidence: 99%

Total Wrist Arthroplasty for Posttraumatic Wrist Osteoarthritis: A Cohort Study Comparing Three Indications

Holzbauer

Mihalic

Pollak

et al. 2022

Life

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Scapholunate ligament ruptures and scaphoid nonunion with consecutive advanced collapse (SLAC and SNAC wrists) as well as intra-articular distal radius fractures (DRF) are prone to cause posttraumatic wrist osteoarthritis. The aim of this study was to compare the outcomes of these indications for total wrist arthroplasty. We included 13, 11, and 8 patients with an overall mean age of 60 ± 9 years in the SLAC, SNAC, and DRF cohort, respectively. After an average follow-up period of 6 ± 3 years, we found no difference between our groups regarding pain levels and functional scores, although these parameters significantly improved compared to preoperative parameters. Complication and revision rates revealed no significant difference. However, significantly higher extension, arc of range of motion values in the flexion-extension, as well as in radial-ulnar deviation plain were detected in the SLAC compared to the DRF group. Finally, TWA proved to show a beneficial performance in all three investigated indications.

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Section: Discussionmentioning

confidence: 99%

Total Wrist Arthroplasty for Posttraumatic Wrist Osteoarthritis: A Cohort Study Comparing Three Indications

Holzbauer

Mihalic

Pollak

et al. 2022

Life

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“…Direct costs of antibiotics for superficial infection, anesthesia and surgeon payments for incision and drainage surgery for deep infection (see Appendix III), return clinic visits, and electromyography/nerve conduction studies were obtained from the literature [50][51][52] (Table III). Wrist incision and drainage costs were calculated with use of Medicare payments as previously described 53 . Direct costs for wound infection included the surgical cost for incision and drainage, a preoperative return patient visit, and oral antibiotics 51 .…”

Section: Costmentioning

confidence: 99%

Optimizing Costs and Outcomes for Carpal Tunnel Release Surgery

Rogers

Stephens

Yoo

et al. 2021

Journal of Bone and Joint Surgery

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Background:It is unclear which carpal tunnel release (CTR) strategy (i.e., which combination of surgical technique and setting) is most cost-effective. A cost-effectiveness analysis was performed to compare (1) open CTR in the procedure room (OCTR/PR), (2) OCTR in the operating room (OCTR/OR), and (3) endoscopic CTR in the operating room (ECTR/OR).Methods:A decision analytic model was used to compare costs and health utilities between treatment strategies. Utility and probability parameters were identified from the literature. Medical costs were estimated with Medicare ambulatory surgical payment data. Indirect costs were related to days out of work due to surgical recovery and complications. The effectiveness outcome was quality-adjusted life years (QALYs). Probabilistic sensitivity analyses and one-way sensitivity analyses were performed. Cost-effectiveness was assessed from the societal and health-care system perspectives with use of a willingness-to-pay threshold of $100,000/QALY.Results:In the base-case analysis, OCTR/PR was more cost-effective than OCTR/OR and ECTR/OR from the societal perspective. The mean total costs and QALYs per patient were $29,738 ± $4,098 and 0.88 ± 0.08 for OCTR/PR, $30,002 ± $4,098 and 0.88 ± 0.08 for OCTR/OR, and $41,311 ± $4,833 and 0.87 ± 0.08 for ECTR/OR. OCTR/PR was also the most cost-effective strategy from the health-care system perspective. These findings were robust in the probabilistic sensitivity analyses: OCTR/PR was the dominant strategy (greater QALYs at a lower cost) in 55% and 61% of iterations from societal and health-care system perspectives, respectively. One-way sensitivity analysis demonstrated that OCTR/PR and OCTR/OR remained more cost-effective than ECTR/OR from a societal perspective under the following conditions: $0 surgical cost of ECTR, 0% revision rate following ECTR, equalization of the return-to-work rate between OCTR and ECTR, or 0 days out of work following ECTR. OCTR/OR became more cost-effective than OCTR/PR with the median nerve injury rate tripling and doubling from societal and health-care system perspectives, respectively, or if surgical direct costs in the PR exceeded those in the OR.Conclusions:Compared with OCTR/OR and ECTR/OR, OCTR/PR minimizes costs to the health-care system and society while providing favorable outcomes.Level of Evidence:Economic and Decision Analysis Level III. See Instructions for Authors for a complete description of levels of evidence.

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“…However, some study groups suggest that FCA may be superior in terms of grip strength, while PRC may be preferable in terms of ROM, postoperative complications, and secondary operations [9][10][11][12]. Some studies indicate that PRC is more cost-effective [13,14], while Daar et al [15] concluded that FCA with cannulated compression screws is the most cost-effective approach. A long-term study reported fewer arthritic changes after FCA versus PRC.…”

Section: Introduction Background and Rationale {6a}mentioning

confidence: 99%

Proximal ROw carpectOmy versus four-corner Fusion (PROOF-trial) for osteoarthritis of the wrist: Study protocol for multi-institutional double-blinded randomized controlled trial

Alanen

Stjernberg-Salmela

Waris

et al. 2022

Preprint

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Background Scapholunate advanced collapse (SLAC) and scaphoid non-union advanced collapse (SNAC) are common types of wrist osteoarthritis (OA). Non-operative treatment consists of pain medication, splinting, and avoiding activities that induce pain. However, in case a course of conservative treatment is unsuccessful, operative treatment is needed. The two most conventional operative approaches for SLAC/SNAC OA are four-corner arthrodesis (FCA) and proximal row carpectomy (PRC). Although FCA is the gold-standard operative technique and may lead to superior grip strength, the evident benefit of PRC is that it obviates any need for hardware removal and controlling for bony union. To date, no high-quality randomized controlled trial comparing FCA and PRC exists. As clinical outcomes seem comparable, a trial that assesses patient-reported outcomes, adverse events, and secondary operations may guide clinical decision making between these two procedures. Thus, the aim of this multi-institutional double-blind randomized controlled trial is to study whether PRC is non-inferior to FCA in treating SLAC/SNAC OA. Methods The trial is designed as a randomized, controlled, patient- and outcome-assessor blinded multicenter, two-armed 1:1 non-inferiority trial. Patients with SLAC/SNAC-induced wrist pain meeting trial inclusion criteria will undergo wrist arthroscopy to further assess eligibility. Each patient eligible for the trial will be randomly assigned to undergo either FCA or PRC. The primary endpoint of this study is the Patient Rated Wrist Evaluation (PRWE) at 1-year after FCA versus PRC. Secondary outcomes include Quick-Disabilities of the Arm, Shoulder and Hand, EQ-5D-5L, pain, grip strength, wrist active range of motion, radiographic evaluation, and adverse events. Trial design, methods, and statistical analysis plan will be presented here. Discussion We present an RCT design comparing FCA vs PRC for SLAC/SNAC-induced OA. The results of this trial will assist in decision making when planning surgery for SLAC/SNAC. Trial registration: ClinicalTrials.gov NCT04260165. Registered February 7, 2020.

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Cost-Effectiveness Analysis Comparing Proximal Row Carpectomy and Four-Corner Arthrodesis

Cited by 9 publications

References 53 publications

Total Wrist Arthroplasty for Posttraumatic Wrist Osteoarthritis: A Cohort Study Comparing Three Indications

Total Wrist Arthroplasty for Posttraumatic Wrist Osteoarthritis: A Cohort Study Comparing Three Indications

Optimizing Costs and Outcomes for Carpal Tunnel Release Surgery

Proximal ROw carpectOmy versus four-corner Fusion (PROOF-trial) for osteoarthritis of the wrist: Study protocol for multi-institutional double-blinded randomized controlled trial

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