Cost-Effectiveness of Trapeziometacarpal Dual Mobility Implant Arthroplasty Compared to Resection Arthroplasty.

Abstract

The aim of our study was to perform a cost-utility analysis comparing trapeziometacarpal joint (TMJ) implant arthroplasty with resection-suspension-interposition arthroplasty (RSIA) during 1 year after surgery. We compared 80 working patients undergoing TMJ implant arthroplasty with 39 working patients receiving RSIA. Over 1 year, we assessed return to work, costs because of loss of productivity, quality-adjusted life-years (QALYs), and direct medical costs. Sensitivity analyses were conducted to extrapolate data over 5 years as well as to account for the data of nonworking patients. Implant arthroplasty patients returned to work significantly faster (mean 52 vs 84 days), leading to reduced costs due to productivity loss. Patients with TMJ implant arthroplasty had significantly higher QALYs (0.89 vs 0.85) and lower total costs (USD 26,809 vs USD 33,953), resulting in a negative incremental cost-effectiveness ratio. At a threshold of USD 110,000 per QALY, implant arthroplasty was found to be cost effective with 99% probability. Sensitivity analyses showed that implant arthroplasty was cost effective over 5 years, despite higher revision risks and also if nonworking patients were included in the population. The study indicates that TMJ implant arthroplasty is less expensive and improves quality of life more effectively than RSIA. Economic 1c.