Early Arthroscopic Debridement May Be More Cost-Effective Than Nonoperative Management for Symptomatic Osteochondritis Dissecans Lesions of the Capitellum
Purpose: To compare the cost-effectiveness of an initial trial of nonoperative treatment to that of early arthroscopic debridement for stable osteochondritis dissecans (OCD) lesions of the capitellum. Methods: A Markov Chain Monte Carlo probabilistic model was developed to evaluate the outcomes and...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2024-02-01
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| Series: | Arthroscopy, Sports Medicine, and Rehabilitation |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666061X23001876 |
| _version_ | 1797302473861365760 |
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| author | Jacob F. Oeding, M.S. Nathan R. Graden, M.D. Aaron J. Krych, M.D. Joaquin Sanchez-Sotelo, M.D., Ph.D. Jonathan D. Barlow, M.D. Christopher L. Camp, M.D. |
| author_facet | Jacob F. Oeding, M.S. Nathan R. Graden, M.D. Aaron J. Krych, M.D. Joaquin Sanchez-Sotelo, M.D., Ph.D. Jonathan D. Barlow, M.D. Christopher L. Camp, M.D. |
| author_sort | Jacob F. Oeding, M.S. |
| collection | DOAJ |
| description | Purpose: To compare the cost-effectiveness of an initial trial of nonoperative treatment to that of early arthroscopic debridement for stable osteochondritis dissecans (OCD) lesions of the capitellum. Methods: A Markov Chain Monte Carlo probabilistic model was developed to evaluate the outcomes and costs of 1,000 simulated patients undergoing nonoperative management versus early arthroscopic debridement for stable OCD lesions of the capitellum. Health utility values, treatment success rates, and transition probabilities were derived from the published literature. Costs were determined on the basis of the typical patient undergoing each treatment strategy at our institution. Outcome measures included costs, quality-adjusted life-years (QALYs), and the incremental cost-effectiveness ratio (ICER). Results: Mean total costs resulting from nonoperative management and early arthroscopic debridement were $5,330 and $21,672, respectively. On average, early arthroscopic debridement produced an additional 0.64 QALYS, resulting in an ICER of $25,245/QALY, which falls well below the widely accepted $50,000 willingness-to-pay (WTP) threshold. Overall, early arthroscopic debridement was determined to be the preferred cost-effective strategy in 69% of patients included in the microsimulation model. Conclusions: Results of the Monte Carlo microsimulation and probabilistic sensitivity analysis demonstrated early arthroscopic debridement to be a cost-effective treatment strategy for the majority of stable OCD lesions of the capitellum. Although early arthroscopic debridement was associated with higher total costs, the increase in QALYS that resulted from early surgery was enough to justify the cost difference based on an ICER substantially below the $50,000 WTP threshold. Level of Evidence: Level III, economic computer simulation model. |
| first_indexed | 2024-03-07T23:38:18Z |
| format | Article |
| id | doaj.art-675963e606c047e8b34beb1c5a1467b3 |
| institution | Directory Open Access Journal |
| issn | 2666-061X |
| language | English |
| last_indexed | 2024-03-07T23:38:18Z |
| publishDate | 2024-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Arthroscopy, Sports Medicine, and Rehabilitation |
| spelling | doaj.art-675963e606c047e8b34beb1c5a1467b32024-02-20T04:19:45ZengElsevierArthroscopy, Sports Medicine, and Rehabilitation2666-061X2024-02-0161100836Early Arthroscopic Debridement May Be More Cost-Effective Than Nonoperative Management for Symptomatic Osteochondritis Dissecans Lesions of the CapitellumJacob F. Oeding, M.S.0Nathan R. Graden, M.D.1Aaron J. Krych, M.D.2Joaquin Sanchez-Sotelo, M.D., Ph.D.3Jonathan D. Barlow, M.D.4Christopher L. Camp, M.D.5School of Medicine, Mayo Clinic Alix School of Medicine, Rochester, Minnesota, U.S.A.; Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, NorwayDepartment of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A.Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A.Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A.Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A.Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A.; Address correspondence to Christopher L. Camp, M.D., Mayo Clinic, 200 First St., SW, Rochester, MN, 55905, U.S.A.Purpose: To compare the cost-effectiveness of an initial trial of nonoperative treatment to that of early arthroscopic debridement for stable osteochondritis dissecans (OCD) lesions of the capitellum. Methods: A Markov Chain Monte Carlo probabilistic model was developed to evaluate the outcomes and costs of 1,000 simulated patients undergoing nonoperative management versus early arthroscopic debridement for stable OCD lesions of the capitellum. Health utility values, treatment success rates, and transition probabilities were derived from the published literature. Costs were determined on the basis of the typical patient undergoing each treatment strategy at our institution. Outcome measures included costs, quality-adjusted life-years (QALYs), and the incremental cost-effectiveness ratio (ICER). Results: Mean total costs resulting from nonoperative management and early arthroscopic debridement were $5,330 and $21,672, respectively. On average, early arthroscopic debridement produced an additional 0.64 QALYS, resulting in an ICER of $25,245/QALY, which falls well below the widely accepted $50,000 willingness-to-pay (WTP) threshold. Overall, early arthroscopic debridement was determined to be the preferred cost-effective strategy in 69% of patients included in the microsimulation model. Conclusions: Results of the Monte Carlo microsimulation and probabilistic sensitivity analysis demonstrated early arthroscopic debridement to be a cost-effective treatment strategy for the majority of stable OCD lesions of the capitellum. Although early arthroscopic debridement was associated with higher total costs, the increase in QALYS that resulted from early surgery was enough to justify the cost difference based on an ICER substantially below the $50,000 WTP threshold. Level of Evidence: Level III, economic computer simulation model.http://www.sciencedirect.com/science/article/pii/S2666061X23001876 |
| spellingShingle | Jacob F. Oeding, M.S. Nathan R. Graden, M.D. Aaron J. Krych, M.D. Joaquin Sanchez-Sotelo, M.D., Ph.D. Jonathan D. Barlow, M.D. Christopher L. Camp, M.D. Early Arthroscopic Debridement May Be More Cost-Effective Than Nonoperative Management for Symptomatic Osteochondritis Dissecans Lesions of the Capitellum Arthroscopy, Sports Medicine, and Rehabilitation |
| title | Early Arthroscopic Debridement May Be More Cost-Effective Than Nonoperative Management for Symptomatic Osteochondritis Dissecans Lesions of the Capitellum |
| title_full | Early Arthroscopic Debridement May Be More Cost-Effective Than Nonoperative Management for Symptomatic Osteochondritis Dissecans Lesions of the Capitellum |
| title_fullStr | Early Arthroscopic Debridement May Be More Cost-Effective Than Nonoperative Management for Symptomatic Osteochondritis Dissecans Lesions of the Capitellum |
| title_full_unstemmed | Early Arthroscopic Debridement May Be More Cost-Effective Than Nonoperative Management for Symptomatic Osteochondritis Dissecans Lesions of the Capitellum |
| title_short | Early Arthroscopic Debridement May Be More Cost-Effective Than Nonoperative Management for Symptomatic Osteochondritis Dissecans Lesions of the Capitellum |
| title_sort | early arthroscopic debridement may be more cost effective than nonoperative management for symptomatic osteochondritis dissecans lesions of the capitellum |
| url | http://www.sciencedirect.com/science/article/pii/S2666061X23001876 |
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