A Cost-Effectiveness Analysis of Corticosteroid Injections and Open Surgical Release for Trigger Finger
Thompson Zhuang, BA, Sandy Wong, BA, Rhonda Aoki, BA, Edric Zeng, BS, Seul Ku, MS and Robin N Kamal, MD, Stanford University, Redwood City, CA
Introduction: Although corticosteroid injections and surgery are both viable options for the treatment of severe trigger finger, the optimal number of injections to offer prior to surgery remains unknown. We evaluate the cost-effectiveness of corticosteroid injection(s) versus immediate surgery for the treatment of trigger finger.
Materials and Methods: We modeled the costs and outcomes associated with offering up to three steroid injections prior to surgery or immediate surgical release from a U.S. healthcare payer perspective. Costs for commercially-insured and Medicare Advantage patients were obtained from a large administrative claims database. Utilities were estimated from a sample of hand therapists at our institution. We calculated incremental cost-effectiveness ratios (ICERs) to compare treatment strategies and performed a probabilistic sensitivity analysis (PSA) with 10,000 second-order Monte Carlo simulations that simultaneously sampled from the uncertainty distributions of model inputs. A willingness-to-pay (WTP) threshold of $50,000 per quality-adjusted life year (QALY) was used.
Results: Offering three steroid injections prior to surgery was the optimal strategy for both commercially-insured and Medicare Advantage patients (Table 1). Our results were sensitive to the probability of injection site fat necrosis, probability of successful steroid injection, time to symptom relief after injection, and treatment cost. A one-way sensitivity analysis showed that immediate surgical release became cost-effective when the cost of surgery is below $920 or $872 for commercially-insured and Medicare Advantage patients, respectively. Cost-effectiveness acceptability curves are shown in Figure 1.
Conclusions: Offering three steroid injections prior to surgery is the optimal strategy for treating severe trigger finger at a WTP threshold of $50,000/QALY. Multiple treatment strategies exist for treating trigger finger and a cost-effectiveness analysis can help guide clinical decision-making and health policy in the absence of clear patient preferences.
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