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. 2024 Apr 16;16(1):100009.
doi: 10.1055/s-0042-1757179. eCollection 2024 Mar.

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

Seul Ku  1 , Thompson Zhuang  1 , Lauren M Shapiro  1 , Marc J Richard  2 , David S Ruch  2 , Robin N Kamal  1
Affiliations

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

Seul Ku et al. J Hand Microsurg. .

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: TFCC; arthroscopy; cost-effectiveness; debridement; immobilization.

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Figures

Fig. 1
Fig. 1
Schematic of cost-effectiveness model. The square represents a decision node, circles represent chance nodes, and triangles represent terminal nodes. TFCC, triangular fibrocartilage complex.
Fig. 2
Fig. 2
Two-way sensitivity analysis of the duration of immobilization in months and the probability of successful immobilization. Stars represent the modeled immobilization strategies.
See this image and copyright information in PMC

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