Lee Squitieri1, Kevin C Chung, David W Hutton, Patricia B Burns, H Myra Kim, Elham Mahmoudi. 1. Los Angeles, Calif.; and Ann Arbor, Mich. From the Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Southern California; the Robert Wood Johnson Clinical Scholars Program, University of California, Los Angeles; the Department of Surgery, Section of Plastic Surgery, and the Center for Statistical Consultation and Research, University of Michigan; and the Section of Plastic Surgery, University of Michigan Medical School.
Abstract
BACKGROUND: There is a paucity of research evaluating the cost-effectiveness of surgical interventions for rheumatoid arthritis patients. Previous reports have challenged the sustainability of improved outcomes after silicone metacarpophalangeal arthroplasty. The authors conducted an economic evaluation of the long-term health outcomes after silicone metacarpophalangeal arthroplasty. METHODS: The authors performed a 5-year prospective cohort study of 170 patients with rheumatoid arthritis (73 surgical and 97 nonsurgical). Objective functional measurements and patient-rated outcomes using the Michigan Hand Outcomes Questionnaire and the Arthritis Impact Measurement Scale 2 were collected at 3 and 5 years. A cost-effectiveness analysis using direct costs from Medicare outpatient claims data (2006 to 2010) was performed to estimate the incremental cost-effectiveness ratios for both the Michigan and Arthritis Impact Measurement Scale 2 measurements. RESULTS: At 5 years, the authors observed a statistically significant difference in upper extremity outcomes (Michigan Hand Outcomes Questionnaire) between the two groups, with surgical patients having higher outcomes. Costs associated with improved outcomes 5 years after surgery were $787 to $1150 when measured by the Michigan Hand Outcomes Questionnaire and $49,843 to $149,530 when measured by the Arthritis Impact scale. The incremental cost-effectiveness ratios did not substantially increase with their observed surgical revision rate of 5.5 percent (approximately 4 percent increase in incremental cost-effectiveness ratio) or with previously published long-term revision rates of 6.2 percent (approximately 6 percent increase in incremental cost-effectiveness ratio). CONCLUSIONS: Short-term improvements in upper extremity outcomes after silicone metacarpophalangeal arthroplasty are maintained over the 5-year follow-up period. These outcomes are achieved at a relatively low cost, even with the addition of potential surgical complications.
BACKGROUND: There is a paucity of research evaluating the cost-effectiveness of surgical interventions for rheumatoid arthritispatients. Previous reports have challenged the sustainability of improved outcomes after silicone metacarpophalangeal arthroplasty. The authors conducted an economic evaluation of the long-term health outcomes after silicone metacarpophalangeal arthroplasty. METHODS: The authors performed a 5-year prospective cohort study of 170 patients with rheumatoid arthritis (73 surgical and 97 nonsurgical). Objective functional measurements and patient-rated outcomes using the Michigan Hand Outcomes Questionnaire and the Arthritis Impact Measurement Scale 2 were collected at 3 and 5 years. A cost-effectiveness analysis using direct costs from Medicare outpatient claims data (2006 to 2010) was performed to estimate the incremental cost-effectiveness ratios for both the Michigan and Arthritis Impact Measurement Scale 2 measurements. RESULTS: At 5 years, the authors observed a statistically significant difference in upper extremity outcomes (Michigan Hand Outcomes Questionnaire) between the two groups, with surgical patients having higher outcomes. Costs associated with improved outcomes 5 years after surgery were $787 to $1150 when measured by the Michigan Hand Outcomes Questionnaire and $49,843 to $149,530 when measured by the Arthritis Impact scale. The incremental cost-effectiveness ratios did not substantially increase with their observed surgical revision rate of 5.5 percent (approximately 4 percent increase in incremental cost-effectiveness ratio) or with previously published long-term revision rates of 6.2 percent (approximately 6 percent increase in incremental cost-effectiveness ratio). CONCLUSIONS: Short-term improvements in upper extremity outcomes after silicone metacarpophalangeal arthroplasty are maintained over the 5-year follow-up period. These outcomes are achieved at a relatively low cost, even with the addition of potential surgical complications.
Authors: Kevin C Chung; Sandra V Kotsis; Patricia B Burns; Frank D Burke; E F Shaw Wilgis; David A Fox; H Myra Kim Journal: Arthritis Care Res (Hoboken) Date: 2017-06-09 Impact factor: 4.794
Authors: Martin Iglesias; Ángel Uriel Cruz-Reyes; Patricia Butrón; Ricardo Hernández-Agallo; Víctor Antonio Torres de la Barrera; Claudio Reyes-Montero; Marta Durand-Carbajal; Gonzalo Torres-Villalobos Journal: Plast Reconstr Surg Glob Open Date: 2017-04-20