title: Medicare Spending and Evidence-Based Approach in Surgical Treatment of Thumb Carpometacarpal Joint Arthritis: 2001 to 2010.
abstract: BACKGROUND
  Despite equivalent outcomes among surgical treatments of thumb carpometacarpal arthritis, little is known about the variation in spending. Because of its complexities, the authors hypothesized that trapeziectomy with ligament reconstruction and tendon interposition incurs the greatest cost to Medicare compared with other surgical procedures.
  
  
  METHODS
  Using a random 5 percent sample of Medicare beneficiaries diagnosed with thumb carpometacarpal joint arthritis, the authors examined total and out-of-pocket spending for 3530 patients who underwent a surgical treatment between 2001 and 2010. The authors used generalized linear regression models, controlling for patient characteristics and place of surgery, to examine variations in spending.
  
  
  RESULTS
  Eighty-nine percent of patients who underwent surgery received trapeziectomy with ligament reconstruction and tendon interposition, with total and out-of-pocket spending of $2576 (95 percent CI, $2333 to $2843; p < 0.001) and $436 (95 percent CI, $429 to $531; p < 0.001), respectively. Simple complete trapeziectomy was the least expensive procedure, performed in 5 percent of patients, with total and out-of-pocket spending of $1268 (95 percent CI, $1089 to $1476; p < 0.001) and $236 (95 percent CI, $180 to $258; p < 0.001), respectively. Because of increasingly higher facility costs, performing the same procedure in a hospital outpatient setting compared with an ambulatory center would increase Medicare spending by more than two-fold (p < 0.001).
  
  
  CONCLUSIONS
  With a consistent rise in health care spending, adherence to an evidence-based approach in medicine is more important than ever. Most surgeons continue to perform trapeziectomy with ligament reconstruction and tendon interposition, the most expensive surgical option. Medicare could potentially save $7.4 million annually if simple complete trapeziectomy was the procedure of choice.
authors.affiliation: Ann Arbor, Mich.|From the Department of Surgery and the Section of Plastic Surgery, University of Michigan Medical School.
authors.forename: Elham
authors.initials: E
authors.lastname: Mahmoudi
authors.affiliation: Ann Arbor, Mich.|From the Department of Surgery and the Section of Plastic Surgery, University of Michigan Medical School.
authors.forename: Frank
authors.initials: F
authors.lastname: Yuan
authors.affiliation: Ann Arbor, Mich.|From the Department of Surgery and the Section of Plastic Surgery, University of Michigan Medical School.
authors.forename: Meghan E
authors.initials: ME
authors.lastname: Lark
authors.affiliation: Ann Arbor, Mich.|From the Department of Surgery and the Section of Plastic Surgery, University of Michigan Medical School.
authors.forename: Oluseyi
authors.initials: O
authors.lastname: Aliu
authors.affiliation: Ann Arbor, Mich.|From the Department of Surgery and the Section of Plastic Surgery, University of Michigan Medical School.
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Chung
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D052737:Carpometacarpal Joints / Q000601:surgery*; D017046:Cost Savings / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D008023:Ligaments, Articular / Q000601:surgery; D008297:Male; D006278:Medicare / Q000191:economics*; D010003:Osteoarthritis / Q000191:economics* / Q000601:surgery*; D013710:Tendons / Q000637:transplantation; D013933:Thumb / Q000601:surgery*; D051222:Trapezium Bone / Q000601:surgery; D014481:United States