Minimizing Costs for Dorsal Wrist Ganglion Treatment: A Cost-Minimization Analysis

Andrew E Federer; Minkyoung Yoo; Andrew S Stephens; Richard E Nelson; Jesse N Steadman; Andrew R Tyser; Nikolas H Kazmers

doi:10.1016/j.jhsa.2022.09.002

Minimizing Costs for Dorsal Wrist Ganglion Treatment: A Cost-Minimization Analysis

J Hand Surg Am. 2023 Jan;48(1):9-18. doi: 10.1016/j.jhsa.2022.09.002. Epub 2022 Nov 17.

Authors

Andrew E Federer¹, Minkyoung Yoo², Andrew S Stephens¹, Richard E Nelson³, Jesse N Steadman¹, Andrew R Tyser¹, Nikolas H Kazmers⁴

Affiliations

¹ Department of Orthopaedics, University of Utah, Salt Lake City, UT.
² Department of Economics, University of Utah, Salt Lake City, UT.
³ Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT.
⁴ Department of Orthopaedics, University of Utah, Salt Lake City, UT. Electronic address: nkazmers@gmail.com.

Abstract

Purpose: Dorsal wrist ganglions are treated commonly with aspiration, or open or arthroscopic excision in operating room (OR) or procedure room (PR) settings. As it remains unclear which treatment strategy is most cost-effective in yielding cyst resolution, our purpose was to perform a formal cost-minimization analysis from the societal perspective in this context.

Methods: A microsimulation decision analytic model evaluating 5 treatment strategies for dorsal wrist ganglions was developed, ending in either resolution or a single failed open revision surgical excision. Strategies included immediate open excision in the OR, immediate open excision in the PR, immediate arthroscopic excision in the OR, or 1 or 2 aspirations before each of the surgical options. Recurrence and complications rates were pooled from the literature for each treatment type. One-way sensitivity and threshold analyses were performed.

Results: The most cost-minimal strategy was 2 aspiration attempts before open surgical excision in the PR setting ($1,603 ± 1,595 per resolved case), followed by 2 aspirations before open excision in the OR ($1,969 ± 2,165 per resolved case). Immediate arthroscopic excision was the costliest strategy ($6,539 ± 264 per resolved case). Single aspiration preoperatively was more cost-minimal than any form of immediate surgery ($2,918 ± 306 and $4,188 ± 306 per resolved case performed in the PR and OR, respectively).

Conclusions: From the societal perspective, performing 2 aspirations before surgical excision in the PR setting was the most cost-minimal treatment strategy, although in reference to surgeons who do not perform this procedure in the PR setting, open excision in the OR was nearly as cost-effective. As patient preferences may preclude routinely performing 2 aspirations, performing at least 1 aspiration before surgical excision improves the cost-effectiveness of dorsal wrist ganglions treatment.

Type of study/level of evidence: Economic Decision Analysis II.

Keywords: Cost-minimization analysis; dorsal wrist ganglion; ganglion cyst; ganglion cyst excision.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Arthroscopy / methods
Costs and Cost Analysis
Ganglion Cysts* / surgery
Humans
Treatment Outcome
Wrist* / surgery

Abstract

Publication types

MeSH terms

Grants and funding