| Cost-effectiveness of open partial fasciectomy, needle aponeurotomy, and collagenase injection for dupuytren contracture. | |
| | |
MedLine Citation:
|
PMID: 21981831 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
PURPOSE: We undertook a cost-utility analysis to compare traditional fasciectomy for Dupuytren with 2 new treatments, needle aponeurotomy and collagenase injection. METHODS: We constructed an expected-value decision analysis model with an arm representing each treatment. A survey was administered to a cohort of 50 consecutive subjects to determine utilities of different interventions. We conducted multiple sensitivity analyses to assess the impact of varying the rate of disease recurrence in each arm of the analysis as well as the cost of the collagenase injection. The threshold for a cost-effective treatment is based on the traditional willingness-to-pay of $50,000 per quality-adjusted life years (QALY) gained. RESULTS: The cost of open partial fasciectomy was $820,114 per QALY gained over no treatment. The cost of needle aponeurotomy was $96,474 per QALY gained versus no treatment. When we performed a sensitivity analysis and set the success rate at 100%, the cost of needle aponeurotomy was $49,631. When needle aponeurotomy was performed without surgical center or anesthesia costs and with reduced hand therapy, the cost was $36,570. When a complete collagenase injection series was priced at $250, the cost was $31,856 per QALY gained. When the injection series was priced at $945, the cost was $49,995 per QALY gained. At the market price of $5,400 per injection, the cost was $166,268 per QALY gained. CONCLUSIONS: In the current model, open partial fasciectomy is not cost-effective. Needle aponeurotomy is cost-effective if the success rate is high. Collagenase injection is cost-effective when priced under $945. TYPE OF STUDY/LEVEL OF EVIDENCE: Economic and Decision Analysis II. |
| | |
Authors:
|
Neal C Chen; Melissa J Shauver; Kevin C Chung |
Publication Detail:
|
Type: Comparative Study; Journal Article; Research Support, N.I.H., Extramural Date: 2011-10-05 |
Journal Detail:
|
Title: The Journal of hand surgery Volume: 36 ISSN: 1531-6564 ISO Abbreviation: J Hand Surg Am Publication Date: 2011 Nov |
Date Detail:
|
Created Date: 2011-10-31 Completed Date: 2012-02-27 Revised Date: 2012-03-02 |
Medline Journal Info:
|
Nlm Unique ID: 7609631 Medline TA: J Hand Surg Am Country: United States |
Other Details:
|
Languages: eng Pagination: 1826-1834.e32 Citation Subset: IM |
Copyright Information:
|
Copyright © 2011 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved. |
Affiliation:
|
Department of Orthopaedic Surgery and the Section of Plastic Surgery, University of Michigan Medical School, Ann Arbor, MI, USA. nealchen@yahoo.com |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Aged Analysis of Variance Cohort Studies Collagenases / economics, therapeutic use* Cost-Benefit Analysis Cross-Sectional Studies Decision Support Techniques Dupuytren Contracture / economics*, surgery*, therapy Fascia / surgery* Female Follow-Up Studies Hospital Costs* Humans Injections, Intralesional Male Middle Aged Orthopedic Procedures / economics*, methods Quality-Adjusted Life Years Recovery of Function Recurrence Risk Assessment Severity of Illness Index Surgical Procedures, Minimally Invasive / economics, methods Treatment Outcome |
| Grant Support | |
ID/Acronym/Agency:
|
K24 AR053120/AR/NIAMS NIH HHS |
| Chemical | |
Reg. No./Substance:
|
EC 3.4.24.-/Collagenases |
| Comments/Corrections | |
Comment In:
|
J Hand Surg Am. 2012 Feb;37(2):394; author reply 394-5
[PMID:
22281175
]
|
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Intra-Articular Fractures of the Distal Radius Evaluated by Computed Tomography.
Next Document: SNAP-23 and syntaxin-3 are required for chemokine release by mature human mast cells.