Cost-Effectiveness of Contemporary Trigger Finger Treatment Strategies: A Medicare Payer Perspective

Trigger finger is typically managed with corticosteroid injections followed by surgical release if injections fail. Office-based ultrasound-guided percutaneous A1 pulley release (USGPR) has emerged as a contemporary alternative that provides definitive surgical treatment in office settings, potentially eliminating both the recurrence risk of injections and the facility costs of traditional surgery. However, USGPR device costs and cost-effectiveness remain uncertain. Prior cost-effectiveness analyses do not include USGPR as a comparator and use reimbursement data from 2016 and earlier that may not reflect contemporary payment structures. This study evaluated the cost-effectiveness of contemporary trigger finger treatment strategies, including office-based USGPR, from a Medicare payer perspective using current 2025 reimbursement data and determined device cost thresholds at which USGPR becomes cost-effective.

A decision-tree cost-effectiveness analysis was performed over a 1-year time horizon comparing five strategies: up to one, two, or three corticosteroid injections followed by facility-based open A1 pulley release if needed; immediate facility-based open release; and immediate office-based USGPR. Costs were derived from 2025 Medicare reimbursement data. Effectiveness was expressed as quality-adjusted life-years. Deterministic, threshold, and probabilistic sensitivity analyses were performed.

The three-injection strategy was most cost-effective, with expected costs of $513 and net monetary benefit of $39,687 at a willingness-to-pay threshold of $50,000 per quality-adjusted life-year. Probabilistic sensitivity analysis demonstrated this strategy remained cost-effective in 100% of 10,000 simulations. At the base case device cost of $800, office-based USGPR was most expensive at $1,577. However, threshold analyses demonstrated that USGPR would become cost-effective at device costs below $232 relative to the three-injection strategy and below $519 relative to immediate facility-based open release.

Offering up to three corticosteroid injections before surgical release represents the most cost-effective contemporary strategy for trigger finger management from a current Medicare payer perspective. At current device costs, office-based USGPR is not cost-effective, but substantial opportunity exists for this technique to become cost competitive as device costs decline.

Economic and Decision Analysis II.