gms | German Medical Science

Objectives/Interrogation: Knowledge about the costs and benefit of hand surgical interventions is important for surgeons as well as social insurances and health policy decision makers. Little is known about the impact of surgery for trapeziometacarpal osteoarthritis (TMC OA) on the quality of life and costs. Therefore, we examined the impact of surgery for TMC OA on the quality of life, direct medical costs and loss of productivity from the societal perspective in the Swiss health care setting.

Methods: Patients with TMC OA indicated for surgery were included in a prospective study. Quality of life (EQ-5D-5L; [index: 0-1]) and hand function (brief Michigan Hand Questionnaire [brief MHQ: 0-100]) were assessed one year before (pre-OP) and up to one year after surgery (post-OP). Their relationship was explored by regression analysis. Eleven major Swiss insurance companies provided direct medical cost data including all health-related diagnoses to consider potential side effects of the surgery. Indirect costs were assessed using the work productivity and activity impairment questionnaire. The year pre-OP served as the control period. Mean total costs to gain one extra quality adjusted life-year (QALY) were estimated by calculating the incremental cost-effectiveness ratio (ICER). Costs are given in 2018 US$ (with a conversion rate of 1.042 from Swiss Francs to US$).

Results and Conclusions: A total of 151 patients (mean age 65.3 years; 77% female) were included and received surgical treatment either as resection or implant arthroplasty. The mean EQ-5D-5L index improved from 0.69 (pre-OP) to 0.88 (post-OP; p < 0.001) and was significantly associated with the brief MHQ (p < 0.001), which improved from 49 (pre-OP) to 83 (post-OP; p < 0.001). Mean total costs were 11,382 US$ in the year pre-OP and comprised the conservative treatment of TMC OA, comorbidities and productivity losses. In the year post-OP, mean total costs including surgical costs and rehabilitation of TMC OA, comorbidities and productivity losses increased to 16,388 US$. The ICER was 25,834 US$ per QALY gained (95%CI: 12,033 to 39,636 US$/QALY) one year post-OP compared to the pre-OP control period.

TMC OA surgery using either resection or implant arthroplasty results in a clinically relevant and statistically significant increase in function and quality of life one year after the intervention. The cost-utility ratio of 26,000 US$ is clearly below the discussed Swiss threshold of about 100,000 US$/QALY.