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

Area of Science:

• Orthopedic Surgery
• Health Economics
• Biostatistics

Background:

• Optimal surgical treatment for scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) is debated.
• Proximal row carpectomy (PRC) and four-corner arthrodesis (FCA) are common surgical interventions.

Purpose of the Study:

• To conduct a cost-effectiveness analysis comparing PRC and FCA for SLAC and SNAC.
• To inform clinical decision-making regarding surgical treatment options.

Main Methods:

• A Markov microsimulation model evaluated clinical outcomes, costs, and quality-adjusted life years (QALYs) over a 10-year horizon.
• Data on transition probabilities, costs, and utilities were sourced from published literature and Medicare data.
• Probabilistic sensitivity analysis and threshold analysis were performed to assess model robustness.

Main Results:

• PRC demonstrated lower total costs ($30,970 vs. $44,526) and comparable effectiveness (8.24 vs. 8.23 QALYs) compared to FCA in the base-case analysis.
• PRC dominated FCA in 57% of probabilistic sensitivity analysis iterations.
• PRC was identified as the most cost-effective strategy across various willingness-to-pay thresholds.

Conclusions:

• PRC is the dominant strategy over FCA in both base-case and probabilistic analyses.
• PRC is suggested as the optimal surgical approach for Stage I or II SLAC and for SNAC in patients aged 55 years and older.