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Multi-digit replantation more cost-effective vs single-digit replantation
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LAS VEGAS — Multi-digit finger replantation may be more cost-effective compared with single-digit replantation, according to results presented at the American Society for Surgery of the Hand Annual Meeting.
Alfred P. Yoon, MD, and colleagues performed a model-based cost-effectiveness analysis from a societal perspective for patients who underwent either digit replantation (n=178) or revision amputation (n=79). Researchers compared the two groups based on injury pattern, including single digit without thumb, thumb only, multi-digit without thumb and multi-digit with thumb amputation.
According to Yoon, an incremental cost-effective ratio of less than $100,000 per quality-adjusted life-years gained was defined as being cost-effective and an incremental cost-effective ratio greater than this threshold was not cost-effective.
“Both direct costs, which are physical expenditures for treatment, such as hospital and anesthesia fees, and indirect costs, which are costs not directly accountable to wages lost, were included in the model to assess total cost,” Yoon said in his presentation here. “Age, wage, life expectancy, time off work and complications were variables included in the model.”
Post-injury utility, reduced wages and life expectancy had the largest influence on cost-effectiveness, according to Yoon. He added replantation became more cost-effective after pre-injury wages decreased.
“Again, replantation remained cost-effective, even for patients with higher income for multi-digit injury patterns,” Yoon said. “With more days off work after replantation, replantation became more expensive and less cost-effective compared to revision amputation.”
Results presented at the meeting showed that replantation was cost-effective for all amputation injury patterns, but multi-digit injuries had a higher rate of cost-effectiveness than single-digit injuries for replantation.
“Replantation is a cost-effective treatment for multi-digit injuries and when technically feasible, should be heavily considered,” Yoon noted. “Single-digit amputation injury replantation has a high likelihood of being cost-effective in patients under the age of 44 [yeas], healthy patients with expected longevity, pre-injury rate under $35,000 and motivated patients who desire to return to work sooner.” – by Erin T. Welsh
Reference:
Yoon AP, et al. Abstract 38. Presented at: American Society for Surgery of the Hand Annual Meeting; Sept. 5-7, 2019; Las Vegas
Disclosure: Yoon reports no relevant financial disclosures.