"Proximal Row Carpectomy versus Four-Corner Arthrodesis for the Treatment of SLAC/SNAC Wrist: A Cost-Utility Analysis"

Plastic and Reconstructive Surgery
David A DaarJacques Hacquebord

Abstract

Two mainstay surgical options for salvage in scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) include proximal row carpectomy (PRC) and four-corner arthrodesis (4CA). This study evaluates the cost-utility of PRC versus three methods of 4CA for the treatment of SLAC/SNAC wrist. cost-utility analysis was performed in accordance with the Second Panel on Cost-Effectiveness in Health and Medicine. A comprehensive literature review was performed to obtain the probability of potential complications. Costs were derived using both societal and health care sector perspectives. A visual analog scale survey of expert hand surgeons estimated utilities. Overall cost, probabilities, and quality-adjusted life-years (QALYs) were used to complete a decision tree analysis. Both deterministic and probabilistic sensitivity analyses were performed. Forty studies yielding 1730 SLAC/SNAC wrists were identified. Decision tree analysis determined that both 4CA with screw fixation and PRC were cost-effective options, but 4CA with screw was the optimal treatment strategy. 4CA with K-wire fixation and 4CA with plate fixation were dominated (inferior) strategies and therefore not cost-effective. One-way sensitivity analys...Continue Reading

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Citations

Oct 9, 2019·Clinical Orthopaedics and Related Research·Sophie SchleusserTobias Kisch
Oct 31, 2020·JB & JS Open Access·Minkyoung YooNikolas H Kazmers

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