title: Economic analysis of revision amputation and replantation treatment of finger amputation injuries.
abstract: BACKGROUND
  The purpose of this study was to perform a cost-utility analysis to compare revision amputation and replantation treatment of finger amputation injuries across a spectrum of injury scenarios.
  
  
  METHODS
  The study was conducted from the societal perspective. Decision tree models were created for the reference case (two-finger amputation injury) and seven additional injury scenarios for comparison. Inputs included cost, quality of life, and probability of each health state. A Web-based time trade-off survey was created to determine quality-adjusted life-years for health states; 685 nationally representative adult community members were invited to participate in the survey. Overall cost and quality-adjusted life-years for revision amputation and replantation were calculated for each decision tree. An incremental cost-effectiveness ratio was calculated if a treatment was more costly but more effective.
  
  
  RESULTS
  The authors had a 64 percent response rate (n = 437). Replantation treatment had greater costs and quality-adjusted life-years compared with revision amputation in all injury scenarios. Replantation of single-digit injuries had the highest incremental cost-effectiveness ratio ($136,400 per quality-adjusted life-year gained). Replantation of three- and four-digit amputation injuries had relatively low cost-to-benefit ratios ($27,100 and $23,800 per quality-adjusted life-year, respectively). Replantation for distal thumb amputation had a relatively low incremental cost-effectiveness ratio ($26,300 per quality-adjusted life-year) compared with replantation of nonthumb distal amputations ($60,200 per quality-adjusted life-year).
  
  
  CONCLUSIONS
  The relative cost per quality-adjusted life-year gained with replantation treatment varied greatly among the injury scenarios. Situations in which indications for replantation are debated had higher cost per quality-adjusted life-year gained. This study highlights variability in value for replantation among different injury scenarios.
authors.affiliation: Ann Arbor, Mich. From the Section of Plastic Surgery, Department of Surgery, and the Department of Pediatrics and Communicable Diseases, University of Michigan Health System; and the Veterans Administration Health System.
authors.forename: Erika Davis
authors.initials: ED
authors.lastname: Sears
authors.forename: Ryan
authors.initials: R
authors.lastname: Shin
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Prosser
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Chung
mesh_terms: D000293:Adolescent; D000328:Adult; D000673:Amputation, Traumatic / Q000191:economics* / Q000601:surgery; D017281:Cost of Illness; D003663:Decision Trees; D005260:Female; D005383:Finger Injuries / Q000191:economics / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D012086:Reoperation / Q000191:economics; D012092:Replantation / Q000191:economics*; D014481:United States; D055815:Young Adult