A cost-utility analysis of open A1 pulley release for the treatment of trigger finger

Abstract

The United Kingdom National Institute for Health and Care Excellence considers a procedure to be cost-effective if the cost per quality-adjusted life year gained falls below a threshold of £20,000–£30,000 (€22,600–33,900; US$24,600–$36,900). This study used cost per quality-adjusted life year methodology to determine the cost-utility ratio of A1 pulley release. Pre- and postoperative EuroQol 5 Dimensions 5 Likert scores were collected prospectively over 6 years from 192 patients. The median pre- and postoperative indices derived from the EuroQol 5 Dimensions 5 Likert scores were significantly different at 0.77 and 0.80. The mean life expectancy was 21 years. The mean number of quality-adjusted life years gained was 1 per patient. The mean cost-utility ratio per patient was £32,308 (€36,508; US$39,730) and £16,154 (€18,254; US$19,869) at 1 and 2 years, respectively. Provided the benefit of surgery was maintained over the remaining life expectancy, the cost-utility ratio decreased to £1537 (€1737; US$1891) per patient. A1 pulley release is cost-effective provided the benefit is maintained for 2 years. The procedure is also associated with a statistically significant improvement in quality of life. Level of evidence: III

What’s new in carpal tunnel syndrome? Commentary and personal opinions

“…We have demonstrated that the local pathway in our department, which is reliant on readily available neurophysiology with a technician-led service, allows us to significantly reduce the number of new patient appointments required. Our pathway developed in this way because of the availability of local resources rather than any proven superiority of neurophysiology over USS (Stirling et al., 2020).…”

“…This has led some to argue whether the value should be discounted with time, with 3% or 5% suggested as possible constant discounting values (Severens and Milne, 2004). Previously published cost utility analyses in this journal have incorporated the discounting principle to the calculation of cost per QALY (Stirling et al., 2020).…”