Research associate University of Utah Park City, Utah
Background and/or Objectives: Corticosteroid injection (CSI) and surgical release are effective options for treating De Quervain’s tendinopathy (DQ). Costs are affected by setting in the procedure room (PR) versus operating room (OR), but both settings require time off of work (OOW) associated with lost wages. Our purpose was to identify the most cost-minimizing DQ treatment pathway in societal perspective considering time OOW.
Design: A microsimulation decision analytic model compared eight treatment pathways. The model concluded with resolution or with surgical release. Resolution rates following CSI were derived from the literature. Direct costs were derived from current literature and our institutional cost database. Indirect costs related to wages were derived from the US Bureau of Labor and Statistics.
Setting : Initial DQ release in the PR or OR, and up to three CSIs prior to release in the PR or OR.
Main Outcome Measures: Costs of eight treatment pathways: initial DQ release in the PR or OR, and up to three CSIs prior to release in the PR or OR.
Results: Recurrence following CSIs are 37 ± 4%, 31% ± 2%, and 50% ± 10%. Initial treatment with DQ release in the PR was the most cost-minimal strategy among patients taking 0 days OOW postoperatively ($427 per resolved case). For patients taking 2 days or 2 weeks OOW, 3 CSI’s prior to release in the PR was the most cost-minimal pathway ($604 and $710 respectively). Initial DQ release in the OR was the most costly treatment, independent of days OOW.
Conclusions: The optimal DQ treatment pathway depends on patient OOW. For patients with 0 days OOW, treatment with DQR in the PR without prior CSI minimizes costs. For patients taking 2 days or 2 weeks OOW, performing 3 CSIs prior to DQ release in the PR is expected to minimize overall costs to society.
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