Cost effectiveness of different techniques in hallux valgus surgery.
BACKGROUND
Different surgical techniques are available to correct each type of Hallux Valgus (HV) deformity, and all present similar good results. No information is available relative to the cost of each technique compared to their individual success.


OBJECTIVE
To determine the cost-effectiveness-ratio (CER) of five different techniques for HV.


METHODS
We included 245HV surgeries performed in 179 patients. The severity was defined according to radiological parameters. For mild to moderate HV we included the Chevron, Modified-Scarf and Ludloff techniques; for severe HV: either Poscow-osteotomy or Lapidus-arthrodesis fixed with plates or screws. Weighted costs were estimated. CER was expressed in $US dollars per AOFAS-point.


RESULTS
The lowest weighted cost was observed for the Chevron-group, and the highest weighted cost was observed in the Poscow-osteotomy and Lapidus-arthrodesis fixed with plate groups. The AOFAS-score improvement was higher in the Chevron and Modified-Scarf groups. The CER found for Chevron and Modified-Scarf techniques were significantly less than for Poscow and Lapidus-techniques.


CONCLUSIONS
Cost-Effectiveness-Ratio was lower, and therefore better, in the groups with mild to moderate deformities operated with Chevron or Modified-Scarf techniques. In severe HV, the three techniques investigated presented similar CER. CER analysis is an additional factor that can be included in the decision making analysis in hallux valgus surgery. Level of Evidence Level IV, Retrospective Study.
Clínica Alemana-Universidad del Desarrollo, Foot and Ankle Surgeon, Chile.
Emilio
E
Wagner
Clínica Alemana-Universidad del Desarrollo, Foot and Ankle Surgeon, Chile.
Cristian
C
Ortiz
General Physician, Chile.
Karen
K
Torres
General Physician, Chile.
Ivan
I
Contesse
Traumatology and Orthopedic Surgeon, Chile.
Omar
O
Vela
Clínica Alemana-Universidad del Desarrollo, Foot and Ankle Surgeon, Chile. Electronic address: dzanolli@alemana.cl.
Diego
D
Zanolli
D000328:Adult; D000368:Aged; D001174:Arthrodesis / Q000191:economics* / Q000379:methods*; D001860:Bone Plates; D001863:Bone Screws; D015331:Cohort Studies; D003362:Cost-Benefit Analysis / Q000191:economics*; D005260:Female; D006215:Hallux Valgus / Q000000981:diagnostic imaging / Q000601:surgery*; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010027:Osteotomy / Q000191:economics* / Q000379:methods*; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index
AOFAS; Chevron; Cost-effectiveness; Hallux valgus surgery; Lapidus; Ludloff; Modified Scarf; Poscow Osteotomy