title: A 5-Year Cost-Effectiveness Analysis of Silicone Metacarpophalangeal Arthroplasty in Patients with Rheumatoid Arthritis.
abstract: BACKGROUND
  There is a paucity of research evaluating the cost-effectiveness of surgical interventions for rheumatoid arthritis patients. Previous reports have challenged the sustainability of improved outcomes after silicone metacarpophalangeal arthroplasty. The authors conducted an economic evaluation of the long-term health outcomes after silicone metacarpophalangeal arthroplasty.
  
  
  METHODS
  The authors performed a 5-year prospective cohort study of 170 patients with rheumatoid arthritis (73 surgical and 97 nonsurgical). Objective functional measurements and patient-rated outcomes using the Michigan Hand Outcomes Questionnaire and the Arthritis Impact Measurement Scale 2 were collected at 3 and 5 years. A cost-effectiveness analysis using direct costs from Medicare outpatient claims data (2006 to 2010) was performed to estimate the incremental cost-effectiveness ratios for both the Michigan and Arthritis Impact Measurement Scale 2 measurements.
  
  
  RESULTS
  At 5 years, the authors observed a statistically significant difference in upper extremity outcomes (Michigan Hand Outcomes Questionnaire) between the two groups, with surgical patients having higher outcomes. Costs associated with improved outcomes 5 years after surgery were $787 to $1150 when measured by the Michigan Hand Outcomes Questionnaire and $49,843 to $149,530 when measured by the Arthritis Impact scale. The incremental cost-effectiveness ratios did not substantially increase with their observed surgical revision rate of 5.5 percent (approximately 4 percent increase in incremental cost-effectiveness ratio) or with previously published long-term revision rates of 6.2 percent (approximately 6 percent increase in incremental cost-effectiveness ratio).
  
  
  CONCLUSIONS
  Short-term improvements in upper extremity outcomes after silicone metacarpophalangeal arthroplasty are maintained over the 5-year follow-up period. These outcomes are achieved at a relatively low cost, even with the addition of potential surgical complications.
authors.affiliation: Los Angeles, Calif.; and Ann Arbor, Mich. From the Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Southern California; the Robert Wood Johnson Clinical Scholars Program, University of California, Los Angeles; the Department of Surgery, Section of Plastic Surgery, and the Center for Statistical Consultation and Research, University of Michigan; and the Section of Plastic Surgery, University of Michigan Medical School.
authors.forename: Lee
authors.initials: L
authors.lastname: Squitieri
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Chung
authors.forename: David W
authors.initials: DW
authors.lastname: Hutton
authors.forename: Patricia B
authors.initials: PB
authors.lastname: Burns
authors.forename: H Myra
authors.initials: HM
authors.lastname: Kim
authors.forename: Elham
authors.initials: E
authors.lastname: Mahmoudi
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000534:rehabilitation / Q000601:surgery*; D001178:Arthroplasty / Q000191:economics* / Q000379:methods; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D018737:Hand Strength / Q000502:physiology; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008662:Metacarpophalangeal Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000503:physiopathology; D011446:Prospective Studies; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology*; D020127:Recovery of Function; D018570:Risk Assessment; D012720:Severity of Illness Index; D014481:United States