A Cost-Effectiveness Analysis of Corticosteroid Injections and Open Surgical Release for Trigger Finger

Purpose To evaluate the cost-effectiveness of corticosteroid injection(s) versus open surgical release for the treatment of trigger finger. Methods Using a US health care payer perspective, we created a decision tree model to es- timate the costs and outcomes associated with 4 treatment strategies for trigger finger: offering up to 3 steroid injections before to surgery or immediate open surgical release. Costs were obtained from a large administrative claims database. We calculated expected quality -adjusted life -years for each treatment strategy, which were compared using incremental cost- effectiveness ratios. Separate analyses were performed for commercially insured and Medi- care Advantage patients. We performed a probabilistic sensitivity analysis using 10,000 second -order Monte Carlo simulations that simultaneously sampled from the uncertainty distributions of all model inputs. Results Offering 3 steroid injections before surgery was the optimal strategy for both commercially insured and Medicare Advantage patients. The probabilistic sensitivity analysis showed that this strategy was cost-effective 67% and 59% of the time for commercially insured and Medicare Advantage patients, respectively. Our results were sensitive to the probability of injection site fat necrosis, success rate of steroid injections, time to symptom relief after a steroid injection, and cost of treatment. Immediate surgical release became cost- effective when the cost of surgery was below $902 or $853 for commercially insured and Medicare Advantage patients, respectively. Conclusions Multiple treatment strategies exist for treating trigger finger, and our cost- effectiveness analysis helps de fine the relative value of different approaches. From a health care payer perspective, offering 3 steroid injections before surgery is a cost-effective strategy. (J Hand Surg Am. 2020;45(7):597-609. Copyright (C) 2020 by the American Society for Surgery of the Hand. All rights reserved.) Type of study/level of evidence Economic and Decision Analyses II.