Cost Effectiveness of Different Techniques in Hallux Valgus Surgery

NewsBot · Dec 3, 2015

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Cost Effectiveness of Different Techniques in Hallux Valgus Surgery
Emilio Wagner, Cristian Ortiz, Karen Torres, Ivan Contesse, Omar Vela, Diego Zanolli
Foot and Ankle Surgery; Article in Press

Highlights
?Decision for bunion surgery should consider cl?nical, radiological and econimical factors.
?We analyzed cost-effectiveness ratio of 5 different surgical techniques to treat HV.
?Cost-Effectiveness ratio imply US dollar spending per each AOFAS point improvement.
?The Chevron technique showed the smallest CER, with 171 USD/AOFAS point.
?The excess of surgical techniques for HV indicates that no single operation is perfect.
?Analyzing effectiveness, the most effective techniques were the Chevron and Modified Scarf techniques.
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Background
Different surgical techniques are available to correct each type of Hallux Valgus(HV) deformity, and all present similar good results. No information is available relative to the cost of each technique compared to their individual success.

Objective
To determine the cost-effectiveness-ratio (CER) of five different techniques for HV.

Methods
We included 245HV surgeries performed in 179 patients. The severity was defined according to radiological parameters. For mild to moderate HV we included the Chevron, Modified-Scarf and Ludloff techniques; for severe HV: either Poscow-osteotomy or Lapidus-arthrodesis fixed with plates or screws. Weighted costs were estimated. CER was expressed in $US dollars per AOFAS-point.

Results
The lowest weighted cost was observed for the Chevron-group, and the highest weighted cost was observed in the Poscow-osteotomy and Lapidus-arthrodesis fixed with plate groups. The AOFAS-score improvement was higher in the Chevron and Modified-Scarf groups. The CER found for Chevron and Modified-Scarf techniques were significantly less than for Poscow and Lapidus-techniques.

Conclusion
Cost-Effectiveness-Ratio was lower, and therefore better, in the groups with mild to moderate deformities operated with Chevron or Modified-Scarf techniques. In severe HV, the three techniques investigated presented similar CER. CER analysis is an additional factor that can be included in the decision making analysis in hallux valgus surgery.
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NewsBot · Nov 26, 2016

A comparative prospective cohort health economic analysis comparing ankle fusion, isolated great toe fusion and hallux valgus surgery
David T. Lovedayc et al
Foot and Ankle Surgery 25 November 2016

Highlights
•Improvements in outcomes for all three common foot and ankle operations.
•The greatest outcome score improvements were with ankle fusion and 1st MTP joint fusion compared to hallux valgus.
•Health economics analysis suggested all three procedures were favourable compared to threshold levels of cost-effectiveness.
•The costs of ankle fusion and 1st MTPJ fusion were easily within threshold costs per QALY whereas hallux valgus had varying costs making it just favourable.
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This study assessed the health economics and outcomes of three common foot and ankle operations.

Between July 2013 and October 2014 all patients undergoing ankle fusion (AF) for osteoarthritis, first metatarsophalangeal joint fusion for osteoarthritis (MF) or hallux valgus surgery (HV) were included. Patients having additional procedures were excluded. Patients completed the Manchester-Oxford Foot Questionnaire (MOX-FQ), the EuroQol EQ-5D-5L questionnaire and the EQ-VAS on presentation and at least 6 months post-operatively.

63 patients undergoing AF (n = 22), MF (n = 22), or HV (n = 32) completed preoperative and postoperative questionnaires. 76 completed preoperative questionnaires and 63 completed the follow up questionnaires. The follow up questionnaires were completed at a median of 12 months (range 6-24 months) following surgery. The mean age at surgery was 59 years (range 26-85 years). Pre-operative MOX-FQ and EQ-5D-5L scores differed significantly between the three groups with AF and MF patients reporting worse scores compared to HV patients. MOX-FQ and EQ-5D-5L significantly improved in all groups from pre-operative levels. MOX-FQ: AF from 53.8 (CI 56.8–50.8) to 22.9 (CI 30.9–14.9), MF from 43.0 (CI 46.4–39.6) to 12.1 (CI 5.9–18.3), HV from 35.4 (CI 39.0–31.7) to 15.6 (CI 21.1 to 10.1). EQ-5D-5L: AF from 0.30 (CI 0.43–0.17) to 0.66 (CI 0.55–0.77), MF from 0.45(CI 0.52–0.38) to 0.83 (CI 0.07–0.07), HV from 0.71(CI 0.74–0.68) to 0.82 (CI 0.88–0.76). There was no significant difference in the EQ-VAS suggesting it may not be representative of foot and ankle health. Health economics analysis using the EQ-5D-5L data to estimate quality-adjusted life years (QALYs) suggested all three procedures were favourable compared to threshold levels of cost-effectiveness. There were differences in estimated costs between the three operations with AF at £2950 (threshold cost <£5,400) and MF at £1197 (threshold cost <£5,780) and HV varying from £625 to £1688 (threshold cost <£1640).

This study reveals that the joint-specific (MOX-FQ) and generic health (EQ-5D-5L) outcome scores of patients improved after AF, MF and HV. The greatest benefit from surgery was gained in the arthritic patient groups. In the future, the use of large population patient reported outcome measures data may also potentially have implications for prioritisation of healthcare provision, acting as an indicator of foot and ankle surgical procedures that produce the most benefit to patients.
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NewsBot · Dec 20, 2018

Cost-Utility Study of the Economics of Bunion Correction Surgery
Jason M. Sutherland, PhD, Janice Mok, BSc, Guiping Liu, PhD, ...
Foot & Ankle International December 17, 2018

Background:
Bunion correction surgery is a very common procedure to improve patients’ pain and physical function attributable to a misaligned first metatarsophalangeal joint. The objective of this study was to apply a health utility framework to estimate the cost utility of bunion correction surgery.

Methods:
Patients were prospectively recruited from the population of patients seen in a lower-extremity orthopedic clinic and scheduled for isolated bunion surgery. Participants completed EuroQoL’s EQ-5D(3L) to measure patients’ current general health preoperatively and 6 months postoperatively. Participants’ change in quality-adjusted life years (QALYs) were calculated by comparing the difference between postoperative utility values and preoperative utility values. The study had 95 patients representing 53% of eligible patients.

Results:
The mean preoperative utility value was 0.6816 and the mean postoperative value was 0.7451, a statistically significant difference denoting an improvement in self-reported health. The cost per QALY, assuming gains in health accrued for 15 years, was $4911 (the 95% confidence interval ranged from $4736 to $5088). The cost per QALY was highest among the oldest patients. Assuming gains in health accrued for 20 years, the cost per QALY was $3922.

Conclusion:
This study demonstrated that bunion correction surgery was inexpensive relative to its gains in health compared with commonly applied thresholds for women and men in all age groups, though the gains were not uniformly distributed across age categories. Future research should examine the impact of recurrence on the robustness of these findings.
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