Cost of Immediate Surgery Versus Non-operative Treatment for Trigger Finger in Diabetic Patients.
OBJECTIVE
As health care costs continue to rise, providers must increasingly identify and implement cost-effective practice measures without sacrificing quality of care. Corticosteroid injections are an established treatment for trigger finger; however, numerous clinical trials have documented the limited efficacy of these injections in the diabetic population. Furthermore, the most cost-effective treatment strategy for diabetic trigger finger has not been determined. The purpose of this study was to perform a decision analysis to identify the least costly strategy for effective treatment of diabetic trigger finger using existing evidence in the literature.


METHODS
Four treatment strategies for diabetic trigger finger were identified: (1) 1 steroid injection followed by surgical release, (2) 2 steroid injections followed by surgical release, (3) immediate surgical release in the operating room, and (4) immediate surgical release in the clinic. A literature review was conducted to determine success rates of the different treatment strategies. Costing analysis was performed using our institutional reimbursement from Medicare. One-way sensitivity and threshold analysis was utilized to determine the least costly treatment strategy.


RESULTS
The least costly treatment strategy was immediate surgical release in the clinic. In patients with insulin-dependent diabetes mellitus, this strategy results in a 32% and a 39% cost reduction when compared with treatment with 1 or 2 corticosteroid injections, respectively. For 1 or 2 corticosteroid injections to be the most cost-effective strategy, injection failure rates would need to be less than 36% and 34%, respectively. The overall cost of care for immediate surgical release in the clinic was $642.


CONCLUSIONS
Diabetic trigger finger is a common problem faced by hand surgeons, with a variety of acceptable treatment algorithms. Management of diabetic trigger finger with immediate surgical release in the clinic is the most cost-effective treatment strategy, assuming a corticosteroid injection failure rate of at least 34%.


METHODS
Economic/decision III.
Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA.
Gaurav Aman
GA
Luther
Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA.
Praveen
P
Murthy
Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA. Electronic address: PBlazar@partners.org.
Philip E
PE
Blazar
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000191:economics; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D048909:Diabetes Complications / Q000188:drug therapy* / Q000601:surgery*; D017048:Health Care Costs; D006801:Humans; D015552:Injections, Intralesional / Q000191:economics; D019637:Orthopedic Procedures / Q000191:economics*; D052582:Trigger Finger Disorder / Q000188:drug therapy* / Q000191:economics / Q000601:surgery*
D000305:Adrenal Cortex Hormones
A1 pulley release; cost; diabetic; trigger finger