Comparative Cost Analysis of Surgery Versus Neurotoxin Injection for Long-Term Management of Upper-Extremity...

Area of Science:

• Orthopedics
• Neurosurgery
• Health Economics

Background:

• Upper-extremity spasticity, a common symptom of upper motor neuron syndrome, significantly limits function and can lead to contractures.
• Surgical options like hyperselective and selective neurectomies are increasingly recognized for their sustained efficacy in managing spasticity.
• Comparing the long-term cost-effectiveness of surgical interventions versus neurotoxin therapy is crucial for treatment planning.

Purpose of the Study:

• To evaluate the long-term cost-effectiveness of surgical management versus neurotoxin therapy for upper-extremity spasticity.
• To determine the cost-parity point between surgical interventions and repeated neurotoxin injections.
• To compare the economic impact of these treatments across different anatomical levels of the upper extremity.

Main Methods:

• Cost analysis based on Centers for Medicare and Medicaid Services reimbursement rates and drug costs.
• Surgical costs included physician reimbursement and facility fees (hospital outpatient and Ambulatory Surgery Center).
• Neurotoxin costs incorporated physician reimbursement and drug expenses, modeled at 3-month intervals over a 10-year period.

Main Results:

• While neurotoxin therapy has lower initial costs, surgical management becomes more cost-effective over the long term.
• Cost-parity between surgical and neurotoxin treatments is consistently achieved around the 5-year mark.
• Over 10 years, surgical management ($4,009-$24,880) is significantly less expensive than neurotoxin therapy ($18,990-$65,810), especially in Ambulatory Surgery Centers.

Conclusions:

• Hyperselective neurectomy and related tendon procedures present a cost-effective alternative to repeated neurotoxin injections for upper-extremity spasticity.
• Despite higher upfront costs, surgical interventions demonstrate superior long-term economic value.
• Further research is recommended to explore patient-reported outcomes and indirect costs associated with both treatment modalities.