Minimizing Costs for Dorsal Wrist Ganglion Treatment: A Cost-Minimization Analysis.
Cost-minimization analysis
dorsal wrist ganglion
ganglion cyst
ganglion cyst excision
Journal
The Journal of hand surgery
ISSN: 1531-6564
Titre abrégé: J Hand Surg Am
Pays: United States
ID NLM: 7609631
Informations de publication
Date de publication:
01 2023
01 2023
Historique:
received:
13
02
2022
revised:
19
07
2022
accepted:
06
09
2022
pmc-release:
01
01
2024
pubmed:
20
11
2022
medline:
7
1
2023
entrez:
19
11
2022
Statut:
ppublish
Résumé
Dorsal wrist ganglions are treated commonly with aspiration, or open or arthroscopic excision in operating room (OR) or procedure room (PR) settings. As it remains unclear which treatment strategy is most cost-effective in yielding cyst resolution, our purpose was to perform a formal cost-minimization analysis from the societal perspective in this context. A microsimulation decision analytic model evaluating 5 treatment strategies for dorsal wrist ganglions was developed, ending in either resolution or a single failed open revision surgical excision. Strategies included immediate open excision in the OR, immediate open excision in the PR, immediate arthroscopic excision in the OR, or 1 or 2 aspirations before each of the surgical options. Recurrence and complications rates were pooled from the literature for each treatment type. One-way sensitivity and threshold analyses were performed. The most cost-minimal strategy was 2 aspiration attempts before open surgical excision in the PR setting ($1,603 ± 1,595 per resolved case), followed by 2 aspirations before open excision in the OR ($1,969 ± 2,165 per resolved case). Immediate arthroscopic excision was the costliest strategy ($6,539 ± 264 per resolved case). Single aspiration preoperatively was more cost-minimal than any form of immediate surgery ($2,918 ± 306 and $4,188 ± 306 per resolved case performed in the PR and OR, respectively). From the societal perspective, performing 2 aspirations before surgical excision in the PR setting was the most cost-minimal treatment strategy, although in reference to surgeons who do not perform this procedure in the PR setting, open excision in the OR was nearly as cost-effective. As patient preferences may preclude routinely performing 2 aspirations, performing at least 1 aspiration before surgical excision improves the cost-effectiveness of dorsal wrist ganglions treatment. Economic Decision Analysis II.
Identifiants
pubmed: 36402604
pii: S0363-5023(22)00537-8
doi: 10.1016/j.jhsa.2022.09.002
pmc: PMC9812920
mid: NIHMS1837223
pii:
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
9-18Subventions
Organisme : NCATS NIH HHS
ID : UL1 TR002538
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR001067
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR000105
Pays : United States
Organisme : NCRR NIH HHS
ID : UL1 RR025764
Pays : United States
Informations de copyright
Copyright © 2023. Published by Elsevier Inc.
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