A cost-utility analysis of open A1 pulley release for the treatment of trigger finger

The United Kingdom National Institute for Health and Care Excellence considers a procedure to be cost-effective if the cost per quality-adjusted life year gained falls below a threshold of £20,000-£30,000 (€22,600-33,900; US$24,600-$36,900). This study used cost per quality-adjusted life year methodology to determine the cost-utility ratio of A1 pulley release. Pre- and postoperative EuroQol 5 Dimensions 5 Likert scores were collected prospectively over 6 years from 192 patients. The median pre- and postoperative indices derived from the EuroQol 5 Dimensions 5 Likert scores were significantly different at 0.77 and 0.80. The mean life expectancy was 21 years. The mean number of quality-adjusted life years gained was 1 per patient. The mean cost-utility ratio per patient was £32,308 (€36,508; US$39,730) and £16,154 (€18,254; US$19,869) at 1 and 2 years, respectively. Provided the benefit of surgery was maintained over the remaining life expectancy, the cost-utility ratio decreased to £1537 (€1737; US$1891) per patient. A1 pulley release is cost-effective provided the benefit is maintained for 2 years. The procedure is also associated with a statistically significant improvement in quality of life.Level of evidence: III.