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Proximal Row Carpectomy versus Four-Corner Arthrodesis for the Treatment of Scapholunate Advanced Collapse/Scaphoid Nonunion Advanced Collapse Wrist: A Cost-Utility Analysis.
Plast Reconstr Surg. 2019 05; 143(5):1432-1445.PR

Abstract

BACKGROUND

Two mainstay surgical options for salvage in scapholunate advanced collapse and scaphoid nonunion advanced collapse are proximal row carpectomy and four-corner arthrodesis. This study evaluates the cost-utility of proximal row carpectomy versus three methods of four-corner arthrodesis for the treatment of scapholunate advanced collapse/scaphoid nonunion advanced collapse wrist.

METHODS

A cost-utility analysis was performed in accordance with the Second Panel on Cost-Effectiveness in Health and Medicine. A comprehensive literature review was performed to obtain the probability of potential complications. Costs were derived using both societal and health care sector perspectives. A visual analogue scale survey of expert hand surgeons estimated utilities. Overall cost, probabilities, and quality-adjusted life-years were used to complete a decision tree analysis. Both deterministic and probabilistic sensitivity analyses were performed.

RESULTS

Forty studies yielding 1730 scapholunate advanced collapse/scaphoid nonunion advanced collapse wrists were identified. Decision tree analysis determined that both four-corner arthrodesis with screw fixation and proximal row carpectomy were cost-effective options, but four-corner arthrodesis with screw was the optimal treatment strategy. Four-corner arthrodesis with Kirschner-wire fixation and four-corner arthrodesis with plate fixation were dominated (inferior) strategies and therefore not cost-effective. One-way sensitivity analysis demonstrated that when the quality-adjusted life-years for a successful four-corner arthrodesis with screw fixation are lower than 26.36, proximal row carpectomy becomes the optimal strategy. However, multivariate probabilistic sensitivity analysis confirmed the results of our model.

CONCLUSIONS

Four-corner arthrodesis with screw fixation and proximal row carpectomy are both cost-effective treatment options for scapholunate advanced collapse/scaphoid nonunion advanced collapse wrist because of their lower complication profile and high efficacy, with four-corner arthrodesis with screw as the most cost-effective treatment. Four-corner arthrodesis with plate and Kirschner-wire fixation should be avoided from a cost-effectiveness standpoint.

Authors+Show Affiliations

From the Hansjörg Wyss Department of Plastic Surgery and the Department of Orthopedic Surgery, New York University School of Medicine; All Florida Orthopedics; and the Department of Orthopaedic Surgery, University of Pennsylvania Health System.From the Hansjörg Wyss Department of Plastic Surgery and the Department of Orthopedic Surgery, New York University School of Medicine; All Florida Orthopedics; and the Department of Orthopaedic Surgery, University of Pennsylvania Health System.From the Hansjörg Wyss Department of Plastic Surgery and the Department of Orthopedic Surgery, New York University School of Medicine; All Florida Orthopedics; and the Department of Orthopaedic Surgery, University of Pennsylvania Health System.From the Hansjörg Wyss Department of Plastic Surgery and the Department of Orthopedic Surgery, New York University School of Medicine; All Florida Orthopedics; and the Department of Orthopaedic Surgery, University of Pennsylvania Health System.From the Hansjörg Wyss Department of Plastic Surgery and the Department of Orthopedic Surgery, New York University School of Medicine; All Florida Orthopedics; and the Department of Orthopaedic Surgery, University of Pennsylvania Health System.

Pub Type(s)

Comparative Study
Journal Article
Review

Language

eng

PubMed ID

31033826

Citation

Daar, David A., et al. "Proximal Row Carpectomy Versus Four-Corner Arthrodesis for the Treatment of Scapholunate Advanced Collapse/Scaphoid Nonunion Advanced Collapse Wrist: a Cost-Utility Analysis." Plastic and Reconstructive Surgery, vol. 143, no. 5, 2019, pp. 1432-1445.
Daar DA, Shah A, Mirrer JT, et al. Proximal Row Carpectomy versus Four-Corner Arthrodesis for the Treatment of Scapholunate Advanced Collapse/Scaphoid Nonunion Advanced Collapse Wrist: A Cost-Utility Analysis. Plast Reconstr Surg. 2019;143(5):1432-1445.
Daar, D. A., Shah, A., Mirrer, J. T., Thanik, V., & Hacquebord, J. (2019). Proximal Row Carpectomy versus Four-Corner Arthrodesis for the Treatment of Scapholunate Advanced Collapse/Scaphoid Nonunion Advanced Collapse Wrist: A Cost-Utility Analysis. Plastic and Reconstructive Surgery, 143(5), 1432-1445. https://doi.org/10.1097/PRS.0000000000005558
Daar DA, et al. Proximal Row Carpectomy Versus Four-Corner Arthrodesis for the Treatment of Scapholunate Advanced Collapse/Scaphoid Nonunion Advanced Collapse Wrist: a Cost-Utility Analysis. Plast Reconstr Surg. 2019;143(5):1432-1445. PubMed PMID: 31033826.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Proximal Row Carpectomy versus Four-Corner Arthrodesis for the Treatment of Scapholunate Advanced Collapse/Scaphoid Nonunion Advanced Collapse Wrist: A Cost-Utility Analysis. AU - Daar,David A, AU - Shah,Ajul, AU - Mirrer,Joshua T, AU - Thanik,Vishal, AU - Hacquebord,Jacques, PY - 2019/4/30/entrez PY - 2019/4/30/pubmed PY - 2019/5/23/medline SP - 1432 EP - 1445 JF - Plastic and reconstructive surgery JO - Plast Reconstr Surg VL - 143 IS - 5 N2 - BACKGROUND: Two mainstay surgical options for salvage in scapholunate advanced collapse and scaphoid nonunion advanced collapse are proximal row carpectomy and four-corner arthrodesis. This study evaluates the cost-utility of proximal row carpectomy versus three methods of four-corner arthrodesis for the treatment of scapholunate advanced collapse/scaphoid nonunion advanced collapse wrist. METHODS: A cost-utility analysis was performed in accordance with the Second Panel on Cost-Effectiveness in Health and Medicine. A comprehensive literature review was performed to obtain the probability of potential complications. Costs were derived using both societal and health care sector perspectives. A visual analogue scale survey of expert hand surgeons estimated utilities. Overall cost, probabilities, and quality-adjusted life-years were used to complete a decision tree analysis. Both deterministic and probabilistic sensitivity analyses were performed. RESULTS: Forty studies yielding 1730 scapholunate advanced collapse/scaphoid nonunion advanced collapse wrists were identified. Decision tree analysis determined that both four-corner arthrodesis with screw fixation and proximal row carpectomy were cost-effective options, but four-corner arthrodesis with screw was the optimal treatment strategy. Four-corner arthrodesis with Kirschner-wire fixation and four-corner arthrodesis with plate fixation were dominated (inferior) strategies and therefore not cost-effective. One-way sensitivity analysis demonstrated that when the quality-adjusted life-years for a successful four-corner arthrodesis with screw fixation are lower than 26.36, proximal row carpectomy becomes the optimal strategy. However, multivariate probabilistic sensitivity analysis confirmed the results of our model. CONCLUSIONS: Four-corner arthrodesis with screw fixation and proximal row carpectomy are both cost-effective treatment options for scapholunate advanced collapse/scaphoid nonunion advanced collapse wrist because of their lower complication profile and high efficacy, with four-corner arthrodesis with screw as the most cost-effective treatment. Four-corner arthrodesis with plate and Kirschner-wire fixation should be avoided from a cost-effectiveness standpoint. SN - 1529-4242 UR - https://www.unboundmedicine.com/medline/citation/31033826/Proximal_Row_Carpectomy_versus_Four_Corner_Arthrodesis_for_the_Treatment_of_Scapholunate_Advanced_Collapse/Scaphoid_Nonunion_Advanced_Collapse_Wrist:_A_Cost_Utility_Analysis_ DB - PRIME DP - Unbound Medicine ER -