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J Hand Microsurg
DOI: 10.1055/s-0042-1757179
Original Article

Cost-Effectiveness Analysis of Early versus Late Debridement of Superficial Triangular Fibrocartilage Complex Tears

Seul Ku
1   Department of Orthopaedic Surgery, Stanford University, VOICES Health Policy Research Center, Redwood City, California, United States
,
Thompson Zhuang 
1   Department of Orthopaedic Surgery, Stanford University, VOICES Health Policy Research Center, Redwood City, California, United States
,
Lauren M. Shapiro
1   Department of Orthopaedic Surgery, Stanford University, VOICES Health Policy Research Center, Redwood City, California, United States
,
Marc J. Richard
2   Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, United States
,
David S. Ruch
2   Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, United States
,
Robin N. Kamal 
1   Department of Orthopaedic Surgery, Stanford University, VOICES Health Policy Research Center, Redwood City, California, United States
› Author Affiliations Funding The institution of one or more of the authors (RNK) has received, during the study period, funding from an Orthopaedic Research and Education Foundation Mentored Clinician Scientist Grant and National Institutes of Health (number K23AR073307–01).
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Abstract

Background While initial nonoperative management is the conventional approach for superficial triangular fibrocartilage complex (TFCC) tears, a substantial portion of these cases go on to require surgery, and the optimal duration of nonoperative treatment is unknown. In this study, we evaluate the cost-effectiveness of early versus late arthroscopic debridement for the treatment of superficial TFCC tears without distal radioulnar joint (DRUJ) instability.

Methods We created a decision tree to compare the following strategies from a healthcare payer perspective: immediate arthroscopic debridement versus immobilization for 4 or 6 weeks with late debridement as needed. Costs were obtained from the Centers for Medicaid and Medicare Services and a national administrative claims database. Probabilities and health-related quality-of-life measures were obtained from published sources. We conducted sensitivity analyses on model inputs, including a probabilistic sensitivity analysis consisting of 10,000 Monte Carlo simulations.

Results Immobilization for 6 weeks while reserving arthroscopic debridement for refractory cases was both the least costly and most effective strategy. Immediate arthroscopic debridement became cost-effective when success rates of immobilization for 4 or 6 weeks were less than 7.7 or 10.5%, respectively. Our probabilistic sensitivity analysis showed that immobilization for 6 weeks was preferred 97.6% of the time, and immobilization for 4 weeks was preferred 2.4% of the time.

Conclusion Although various early and late debridement strategies can be used to treat superficial TFCC tears without DRUJ instability, immobilization for 6 weeks while reserving arthroscopic debridement for refractory cases is the optimal strategy from a cost-effectiveness standpoint.

Keywords

arthroscopy - cost-effectiveness - debridement - immobilization - TFCC

Supplementary Material



Publication History

Article published online:
18 October 2022

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