Abstract
Hammertoe deformities are one of the most common foot deformities, affecting up to
one third of the general population. Fusion of the joint can be achieved with various
devices, with the current focus on percutaneous Kirschner (K)-wire fixation or commercial
intramedullary implant devices. The purpose of the present study was to determine
whether surgical intervention with percutaneous K-wire fixation versus commercial
intramedullary implant is more cost effective for proximal interphalangeal joint arthrodesis
in hammertoe surgery. A formal cost-effectiveness analysis using a decision analytic
tree model was conducted to investigate the healthcare costs and outcomes associated
with either K-wire or commercial intramedullary implant fixation. The outcomes assessed
included long-term costs, quality-adjusted life-years (QALYs), and incremental cost
per QALY gained. Costs were evaluated from the healthcare system perspective and are
expressed in U.S. dollars at a 2017 price base. Our results found that commercial
implants were minimally more effective than K-wires but carried significantly higher
costs. The total cost for treatment with percutaneous K-wire fixation was $5041 with
an effectiveness of 0.82 QALY compared with a commercial implant cost of $6059 with
an effectiveness of 0.83 QALY. The incremental cost-effectiveness ratio of commercial
implants was $146,667. With an incremental cost-effectiveness ratio of >$50,000, commercial
implants failed to justify their proposed benefits to outweigh their cost compared
to percutaneous K-wire fixation. In conclusion, percutaneous K-wire fixation would
be preferred for arthrodesis of the proximal interphalangeal joint for hammertoes
from a healthcare system perspective.
Level of Clinical Evidence
Keywords
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Article info
Footnotes
Financial Disclosure: This project was supported by an American College of Foot and Ankle Surgeon (ACFAS) Clinical and Scientific Research Grant Award (2016). The content is solely the responsibility of the authors and does not represent the official views of the ACFAS.
Conflict of Interest: None reported.
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