In Reply

Abstract

The question raised by Professor Wiwanitkit is a common one and worthwhile clarifying when discussing cost-effectiveness analyses.It is agreed that there are indirect costs when a patient undergoes surgery, including lost time from work and lost productivity; however, it is important to understand that when a decision analysis is performed, by necessity, the framework is predefined. All decision analyses have a context of original assumptions and inherent limitations that are critically taken into account when evaluating the conclusions.1Chen N.C. Shauver M.J. Chung K.C. A primer on use of decision analysis methodology in hand surgery.J Hand Surg. 2009; 34A: 983-990Google ScholarIn our study, we chose to include only direct medical costs. There is a strong precedent for using direct medical costs in previous studies.2Sharifi E. Sharifi H. Morshed S. Bozic K. Diab M. Cost-effectiveness analysis of periacetabular osteotomy.J Bone Joint Surg. 2008; 90A: 1447-1456Crossref Scopus (40) Google Scholar, 3Soohoo N.F. Sharifi H. Kominski G. Lieberman J.R. Cost-effectiveness analysis of unicompartmental knee arthroplasty as an alternative to total knee arthroplasty for unicompartmental osteoarthritis.J Bone Joint Surg. 2006; 88A: 1975-1982Crossref Scopus (103) Google Scholar In addition, a commonly used benchmark for cost-effectiveness is a cost less than $50,000 per quality-adjusted life years,4Gillick M.R. Medicare coverage for technological innovations—time for new criteria?.N Engl J Med. 2004; 350: 2199-2203Crossref PubMed Scopus (80) Google Scholar the cost per quality-adjusted life years for dialysis. This number is referenced from direct medical costs. Using indirect medical costs for analysis is a legitimate framework but the results are more difficult to contextualize in the face of current literature.We appreciate the commentary and encourage the hand surgery community to continue decision analysis and clinical outcomes research and education. The question raised by Professor Wiwanitkit is a common one and worthwhile clarifying when discussing cost-effectiveness analyses. It is agreed that there are indirect costs when a patient undergoes surgery, including lost time from work and lost productivity; however, it is important to understand that when a decision analysis is performed, by necessity, the framework is predefined. All decision analyses have a context of original assumptions and inherent limitations that are critically taken into account when evaluating the conclusions.1Chen N.C. Shauver M.J. Chung K.C. A primer on use of decision analysis methodology in hand surgery.J Hand Surg. 2009; 34A: 983-990Google Scholar In our study, we chose to include only direct medical costs. There is a strong precedent for using direct medical costs in previous studies.2Sharifi E. Sharifi H. Morshed S. Bozic K. Diab M. Cost-effectiveness analysis of periacetabular osteotomy.J Bone Joint Surg. 2008; 90A: 1447-1456Crossref Scopus (40) Google Scholar, 3Soohoo N.F. Sharifi H. Kominski G. Lieberman J.R. Cost-effectiveness analysis of unicompartmental knee arthroplasty as an alternative to total knee arthroplasty for unicompartmental osteoarthritis.J Bone Joint Surg. 2006; 88A: 1975-1982Crossref Scopus (103) Google Scholar In addition, a commonly used benchmark for cost-effectiveness is a cost less than $50,000 per quality-adjusted life years,4Gillick M.R. Medicare coverage for technological innovations—time for new criteria?.N Engl J Med. 2004; 350: 2199-2203Crossref PubMed Scopus (80) Google Scholar the cost per quality-adjusted life years for dialysis. This number is referenced from direct medical costs. Using indirect medical costs for analysis is a legitimate framework but the results are more difficult to contextualize in the face of current literature. We appreciate the commentary and encourage the hand surgery community to continue decision analysis and clinical outcomes research and education. Cost of Open Partial Fasciectomy, Needle Aponeurotomy, and Collagenase Injection for Dupuytren ContractureJournal of Hand SurgeryVol. 37Issue 2PreviewThe recent publication “Cost-effectiveness of open partial fasciectomy, needle aponeurotomy, and collagenase injection for dupuytren contracture”1 is interesting. Chen et al concluded that “open partial fasciectomy is not cost-effective.”1 Indeed, this work should ideally include a cost-utility study that deals directly with the estimated quality of life adjustment. The medical cost is only 1 important concern included in the cost analysis. Indeed, there are other aspects to be considered, such as indirect cost resulting from loss of work and complications as well as the cost of time required by the practitioner to provide care. Full-Text PDF