Cost Comparison of Synthetic Hydrogel Implant and First Metatarsophalangeal Joint Arthrodesis

Shane D. Rothermel, Jesse L. King, Maegan Tupinio, Kempland C. Walley, Paul Juliano, Michael Aynardi

Research output: Contribution to journalArticle

Abstract

Background. First metatarsophalangeal (MTP) arthrodesis is the “gold standard” treatment for hallux rigidus. Recently, there has been increased interest in new synthetic cartilage implants to preserve joint motion while eradicating pain. With current health care economics, the cost of a treatment is gaining particular importance. This study set out to perform a cost comparison between MTP arthrodesis and synthetic hydrogel implant to determine which treatment modality is more cost-effective based on direct aggregate costs. Study design. Economic and decision analysis. Methods. Studies in the available literature were analyzed to estimate hardware removal rates for MTP fusion and failure rates for a synthetic hydrogel implant and MTP fusion. Costs were determined by examining direct costs at a single institution for implants and data reported in the literature for operating room time. Sensitivity analysis and Monte Carlo simulation were performed to examine cost and measurement uncertainty. Results. Assuming a 4.76% MTP arthrodesis revision rate and 7.06% hardware removal rate, the total direct cost of MTP joint arthrodesis was $3632. Using a 9.2% failure rate with subsequent conversion to MTP arthrodesis, the total cost of synthetic hydrogel implant was $4565. Sensitivity analysis revealed that MTP fusion was more cost-effective even if the failure rate increased to 15% and synthetic hydrogel implant failure rate was 0%. The synthetic cartilage implant cost would have to be reduced 28% or approximately 200% the cost of MTP fusion implants to be comparable to MTP arthrodesis. Conclusion. Hallux rigidus treatment with a synthetic hydrogel implant resulted in a higher direct aggregate cost than MTP arthrodesis. Level of Evidence: Level II: Cost analysis.

Original languageEnglish (US)
JournalFoot and Ankle Specialist
DOIs
StatePublished - Jan 1 2019

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Metatarsophalangeal Joint
Arthrodesis
Hydrogel
Costs and Cost Analysis
Hallux Rigidus
Cartilage
Economics
Decision Support Techniques
Operating Rooms
Health Care Costs
Uncertainty

All Science Journal Classification (ASJC) codes

  • Surgery
  • Podiatry
  • Orthopedics and Sports Medicine

Cite this

@article{e9aa6053d1de4d2786b661402fc3a638,
title = "Cost Comparison of Synthetic Hydrogel Implant and First Metatarsophalangeal Joint Arthrodesis",
abstract = "Background. First metatarsophalangeal (MTP) arthrodesis is the “gold standard” treatment for hallux rigidus. Recently, there has been increased interest in new synthetic cartilage implants to preserve joint motion while eradicating pain. With current health care economics, the cost of a treatment is gaining particular importance. This study set out to perform a cost comparison between MTP arthrodesis and synthetic hydrogel implant to determine which treatment modality is more cost-effective based on direct aggregate costs. Study design. Economic and decision analysis. Methods. Studies in the available literature were analyzed to estimate hardware removal rates for MTP fusion and failure rates for a synthetic hydrogel implant and MTP fusion. Costs were determined by examining direct costs at a single institution for implants and data reported in the literature for operating room time. Sensitivity analysis and Monte Carlo simulation were performed to examine cost and measurement uncertainty. Results. Assuming a 4.76{\%} MTP arthrodesis revision rate and 7.06{\%} hardware removal rate, the total direct cost of MTP joint arthrodesis was $3632. Using a 9.2{\%} failure rate with subsequent conversion to MTP arthrodesis, the total cost of synthetic hydrogel implant was $4565. Sensitivity analysis revealed that MTP fusion was more cost-effective even if the failure rate increased to 15{\%} and synthetic hydrogel implant failure rate was 0{\%}. The synthetic cartilage implant cost would have to be reduced 28{\%} or approximately 200{\%} the cost of MTP fusion implants to be comparable to MTP arthrodesis. Conclusion. Hallux rigidus treatment with a synthetic hydrogel implant resulted in a higher direct aggregate cost than MTP arthrodesis. Level of Evidence: Level II: Cost analysis.",
author = "Rothermel, {Shane D.} and King, {Jesse L.} and Maegan Tupinio and Walley, {Kempland C.} and Paul Juliano and Michael Aynardi",
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Cost Comparison of Synthetic Hydrogel Implant and First Metatarsophalangeal Joint Arthrodesis. / Rothermel, Shane D.; King, Jesse L.; Tupinio, Maegan; Walley, Kempland C.; Juliano, Paul; Aynardi, Michael.

In: Foot and Ankle Specialist, 01.01.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Cost Comparison of Synthetic Hydrogel Implant and First Metatarsophalangeal Joint Arthrodesis

AU - Rothermel, Shane D.

AU - King, Jesse L.

AU - Tupinio, Maegan

AU - Walley, Kempland C.

AU - Juliano, Paul

AU - Aynardi, Michael

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background. First metatarsophalangeal (MTP) arthrodesis is the “gold standard” treatment for hallux rigidus. Recently, there has been increased interest in new synthetic cartilage implants to preserve joint motion while eradicating pain. With current health care economics, the cost of a treatment is gaining particular importance. This study set out to perform a cost comparison between MTP arthrodesis and synthetic hydrogel implant to determine which treatment modality is more cost-effective based on direct aggregate costs. Study design. Economic and decision analysis. Methods. Studies in the available literature were analyzed to estimate hardware removal rates for MTP fusion and failure rates for a synthetic hydrogel implant and MTP fusion. Costs were determined by examining direct costs at a single institution for implants and data reported in the literature for operating room time. Sensitivity analysis and Monte Carlo simulation were performed to examine cost and measurement uncertainty. Results. Assuming a 4.76% MTP arthrodesis revision rate and 7.06% hardware removal rate, the total direct cost of MTP joint arthrodesis was $3632. Using a 9.2% failure rate with subsequent conversion to MTP arthrodesis, the total cost of synthetic hydrogel implant was $4565. Sensitivity analysis revealed that MTP fusion was more cost-effective even if the failure rate increased to 15% and synthetic hydrogel implant failure rate was 0%. The synthetic cartilage implant cost would have to be reduced 28% or approximately 200% the cost of MTP fusion implants to be comparable to MTP arthrodesis. Conclusion. Hallux rigidus treatment with a synthetic hydrogel implant resulted in a higher direct aggregate cost than MTP arthrodesis. Level of Evidence: Level II: Cost analysis.

AB - Background. First metatarsophalangeal (MTP) arthrodesis is the “gold standard” treatment for hallux rigidus. Recently, there has been increased interest in new synthetic cartilage implants to preserve joint motion while eradicating pain. With current health care economics, the cost of a treatment is gaining particular importance. This study set out to perform a cost comparison between MTP arthrodesis and synthetic hydrogel implant to determine which treatment modality is more cost-effective based on direct aggregate costs. Study design. Economic and decision analysis. Methods. Studies in the available literature were analyzed to estimate hardware removal rates for MTP fusion and failure rates for a synthetic hydrogel implant and MTP fusion. Costs were determined by examining direct costs at a single institution for implants and data reported in the literature for operating room time. Sensitivity analysis and Monte Carlo simulation were performed to examine cost and measurement uncertainty. Results. Assuming a 4.76% MTP arthrodesis revision rate and 7.06% hardware removal rate, the total direct cost of MTP joint arthrodesis was $3632. Using a 9.2% failure rate with subsequent conversion to MTP arthrodesis, the total cost of synthetic hydrogel implant was $4565. Sensitivity analysis revealed that MTP fusion was more cost-effective even if the failure rate increased to 15% and synthetic hydrogel implant failure rate was 0%. The synthetic cartilage implant cost would have to be reduced 28% or approximately 200% the cost of MTP fusion implants to be comparable to MTP arthrodesis. Conclusion. Hallux rigidus treatment with a synthetic hydrogel implant resulted in a higher direct aggregate cost than MTP arthrodesis. Level of Evidence: Level II: Cost analysis.

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