Title: Is surgery for trapeziometacarpal osteoarthritis cost effec-tive? : a Swiss health-economic study
Authors : Grobet, Cécile
Audigé, Laurent
Eichler, Klaus
Meier, Flurina
Wieser, Simon
Herren, Daniel
Conference details: Kongress der schweizerischen Gesellschaft für Handchirurgie (SGH-/SGHR) 2018, St. Gallen, 22-23 November 2018
Issue Date: 2018
License (according to publishing contract) : Licence according to publishing contract
Type of review: No review
Language : English
Subject (DDC) : 362: Health and social services
616.7: Diseases of musculoskeletal system and orthopaedics
Abstract: Introduction Knowledge about the costs and benefit of orthopaedic interventions is important for surgeons as well as social insurances and health policy decision makers. Little is known about the impact of common orthopaedic upper extremity procedures on the quality of life and costs in Switzerland. Therefore, the aim of this study was to examine the influence of surgery for trapeziometacarpal osteoarthritis (TMC OA) on the quality of life, direct medical costs and loss of productivity from the societal perspective. Materials and Methods Patients with TMC OA indicated for surgery were included in a prospective study. Quality of life (EQ-5D-5L; [index: 0-1]) and hand function (brief Michigan Hand Questionnaire [brief MHQ: 0-100]) were assessed one year before (pre-OP) and up to one year after surgery (post-OP); their relationship was explored by regression analysis. Sixteen major Swiss insurance companies provided direct medical cost data including all health-related diagnoses to consider potential side effects of the surgery. Indirect costs were assessed using the work productivity and activity impairment questionnaire. The year pre-OP served as the control period. Mean total costs to gain one extra quality adjusted life-year (QALY) were estimated by calculating the incremental cost-effectiveness ratio (ICER) for all patients. Results A total of 152 patients (mean age 65.2 years; 78% female) were included. Patients received a resection-suspension-interposition arthroplasty using either autologous tendons (84%) or an allograft (5%), a resection arthroplasty only (7%), or an implant arthroplasty using a pyrocarbon implant (4%). The mean EQ-5D index improved from 0.68 (pre-OP) to 0.88 (post-OP; p < 0.001) and was significantly associated with the brief MHQ (p < 0.001), which improved from 49 (pre-OP) to 82 (post-OP; p < 0.001). Annual mean total costs for the first 94 patients with complete cost data increased from 11,563 Swiss Francs (CHF) (pre-OP) to 17,722 CHF (post-OP). The ICER was 33,088 CHF per QALY gained (95%CI: 19,337 to 46,839 CHF/QALY) one year post-OP compared to the pre-OP control period. Conclusion TMC OA surgery results in a clinically relevant and statistically significant increase in function and quality of life one year after the intervention. The cost-utility ratio is clearly below the often suggested US$100,000/QALY threshold.
Departement: School of Management and Law
Organisational Unit: Winterthur Institute of Health Economics (WIG)
Publication type: Conference Other
URI: https://digitalcollection.zhaw.ch/handle/11475/15406
Appears in Collections:Publikationen School of Management and Law

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