Reconstructing the Rheumatoid Wrist: A Utility Analysis Comparing Total Wrist Fusion and Total Wrist Arthroplasty from the Perspectives of Rheumatologists and Hand Surgeons

Cavaliere, Christi M.; Oppenheimer, Adam J.; Chung, Kevin C.

doi:10.1007/s11552-009-9194-7

Cited by 18 publications

(8 citation statements)

References 16 publications

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“…Using the principles outlined in this article, the authors have completed survey research on a variety of topics, including practice patterns for venous thromboembolism prophylaxis in breast reconstruction 26 and post-bariatric body contouring, 30 cost-utility and decision making in rheumatoid hand surgery, 27,28 hand transplantation, 29 and the management of lower extremity fractures. 30 A sample survey for Plastic and Reconstructive Surgery readers has been created at www.PRSsurvey.info.…”

Section: Discussionmentioning

confidence: 99%

Survey Says? A Primer on Web-Based Survey Design and Distribution

Oppenheimer

Pannucci

Kasten

et al. 2011

Plastic and Reconstructive Surgery

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The internet has changed the way in which we gather and interpret information. While books were once the exclusive bearers of data, knowledge is now only a keystroke away. The internet has also facilitated the synthesis of new knowledge. Specifically, it has become a tool through which medical research is conducted. A review of the literature reveals that in the past year, over one-hundred medical publications have been based on web-based survey data alone. Due to emerging internet technologies, web-based surveys can now be launched with little computer knowledge. They may also be self-administered, eliminating personnel requirements. Ultimately, an investigator may build, implement, and analyze survey results with speed and efficiency, obviating the need for mass mailings and data processing. All of these qualities have rendered telephone and mail-based surveys virtually obsolete. Despite these capabilities, web-based survey techniques are not without their limitations, namely recall and response biases. When used properly, however, web-based surveys can greatly simplify the research process. This article discusses the implications of web-based surveys and provides guidelines for their effective design and distribution.

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Section: Discussionmentioning

confidence: 99%

Survey Says? A Primer on Web-Based Survey Design and Distribution

Oppenheimer

Pannucci

Kasten

et al. 2011

Plastic and Reconstructive Surgery

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“…Twenty-three studies (41.1%) reported preintervention and postintervention HSUVs, 20 , 22 , 24 , 27 , 29 , 31 , 44 , 45 , 48 – 54 , 57 , 58 , 61 , 63 , 67 – 69 , 73 and 15 (26.8%) 20 , 26 , 27 , 30 , 32 , 34 , 36 , 37 , 57 , 62 , 63 , 66 , 68 , 69 , 74 reported HSUVs associated with procedure-related complications. Three studies (5.3%) looked at HSVUs after aesthetic procedures, including nasal deformity and cosmetic rhinoplasty, 46 hair loss and hair transplant, 53 and thigh lifts.…”

Section: Resultsmentioning

confidence: 99%

A Systematic Review of Health State Utility Values in the Plastic Surgery Literature

Christopher

Morris

Patel

et al. 2021

Plastic and Reconstructive Surgery - Global Open

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Background: Cost-utility analyses assess health gains acquired by interventions by incorporating weighted health state utility values (HSUVs). HSUVs are important in plastic and reconstructive surgery (PRS) because they include qualitative metrics when comparing operative techniques or interventions. We systematically reviewed the literature to identify the extent and quality of existing original utilities research within PRS. Methods: A systematic review of articles with original PRS utility data was conducted in accordance with the Preferred Reporting Items for a Systematic Review and Meta-Analysis guidelines. Subspecialty, survey sample size, and respondent characteristics were extracted. For each HSUV, the utility measure [direct (standard gamble, time trade off, visual analog scale) and/or indirect], mean utility score, and measure of variance were recorded. Similar HSUVs were pooled into weighted averages based on sample size if they were derived from the same utility measure. Results: In total, 348 HSUVs for 194 disease states were derived from 56 studies within seven PRS subspecialties. Utility studies were most common in breast (n = 17, 30.4%) and hand/upper extremity (n = 15, 26.8%), and direct measurements were most frequent [visual analog scale (55.4%), standard gamble (46.4%), time trade off (57.1%)]. Studies surveying the general public had more respondents (n = 165, IQR 103-299) than those that surveyed patients (n = 61, IQR 48-79) or healthcare professionals (n = 42, IQR 10-109). HSUVs for 18 health states were aggregated. Conclusions: The HSUV literature within PRS is scant and heterogeneous. Researchers should become familiar with these outcomes, as integrating utility and cost data will help illustrate that the impact of certain interventions are cost-effective when we consider patient quality of life.

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“…Prior analysis of physician data showed no statistically significant difference between responses for hand surgeons and rheumatologists for all scenarios. (20) Mean utility values for physicians were compared to mean values for patients. Results for Scenario 1, living with a painful RA wrist, show that physicians rate the utility of this health state (mean utility 0.55) much higher than actual patients living with RA (mean utility 0.41).…”

Section: Resultsmentioning

confidence: 99%

A Cost-Utility Analysis of Nonsurgical Management, Total Wrist Arthroplasty, and Total Wrist Arthrodesis in Rheumatoid Arthritis

Cavaliere

Chung²

2010

The Journal of Hand Surgery

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Purpose-Management of end stage rheumatoid wrist disease remains controversial. Total wrist fusion (TWF) provides reliable pain relief and stability and is the most commonly applied management strategy. Total wrist arthroplasty (TWA) is a motion-preserving alternative that is gaining popularity. The purpose of this study is to perform a cost-utility analysis comparing nonoperative management, TWA and TWF for the rheumatoid wrist Methods-A time trade-off utility survey was developed to investigate patient and physician preferences for the potential outcomes of TWA and TWF. The study sample consisted of rheumatoid patients (N=49) recruited as part of an ongoing prospective study as well as a national random sample of hand surgeons and rheumatologists (N=109). A decision tree was created using utility values derived from the survey, and the expected quality-adjusted-life-years (QALYs) for each procedure were determined. Using the societal perspective, costs were based on the Medicare fee schedules for the CPT codes associated with TWA and TWF and their potential complications. Costs per QALY were calculated and compared.Results-Patients and physicians both showed a preference for operative management over nonoperative management. Application of cost data indicated that the incremental cost per additional QALY gained for TWA over non-operative management was $2,281 and the incremental cost per QALY gained with TWA over TWF was $2,328 which is substantially less than the national standard of $50,000/QALY deemed acceptable for adoption.Conclusions-In the absence of rigorous outcome data, cost-utility analysis is a useful tool to guide treatment decisions. TWA and TWF are both extremely cost-effective procedures. This study incorporated patient and physician utilities to demonstrate that TWA has only a small incremental cost over the traditional TWF procedure. Based on this economic model, TWA may be worthy of further consideration and cost should not be considered prohibitive.

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Reconstructing the Rheumatoid Wrist: A Utility Analysis Comparing Total Wrist Fusion and Total Wrist Arthroplasty from the Perspectives of Rheumatologists and Hand Surgeons

Cited by 18 publications

References 16 publications

Survey Says? A Primer on Web-Based Survey Design and Distribution

Survey Says? A Primer on Web-Based Survey Design and Distribution

A Systematic Review of Health State Utility Values in the Plastic Surgery Literature

A Cost-Utility Analysis of Nonsurgical Management, Total Wrist Arthroplasty, and Total Wrist Arthrodesis in Rheumatoid Arthritis

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