Selective First Carpometacarpal Denervation Is Cost-Effective Compared With Trapeziectomy for Thumb Carpometacarpal Arthritis.

PURPOSE: Selective first carpometacarpal (CMC) denervation has gained interest as an alternative to trapeziectomy-based procedures for thumb CMC arthritis, with potential advantages including less soft tissue disruption, faster recovery, and preservation of future trapeziectomy as an option. However, cost-effectiveness data remain limited. We aimed to evaluate the 5-year cost-utility of selective first CMC denervation compared with trapeziectomy and continued nonsurgical management.

METHODS

A hybrid decision-analysis and Markov model was developed for a hypothetical patient with first CMC arthritis who remained symptomatic after 6 months of nonsurgical management. Three strategies were compared over a 5-year horizon: continued nonsurgical management, selective first CMC denervation, and trapeziectomy. Model inputs were derived from a literature review. Costs were modeled from a Medicare Hospital Outpatient Department perspective and discounted at 3% annually. Monte Carlo microsimulation of 1,000 hypothetical patients estimated costs, quality-adjusted life years (QALYs), incremental net monetary benefit, and cost-utility at a willingness-to-pay threshold of $50,000/QALY. Deterministic sensitivity analyses assessed model robustness.

RESULTS

Denervation had lower mean 5-year cost than trapeziectomy ($2,706.39 vs $4,276.96) and slightly greater effectiveness (3.87 vs 3.82 QALYs). Compared with trapeziectomy, denervation saved $1,580.46 and gained 0.06 QALYs (95% CI, 0.05-0.06), with a mean incremental net monetary benefit of $4,384.25. Denervation was preferred in 97.4% of simulations and remained cost-effective across all deterministic sensitivity analyses.

CONCLUSIONS

Selective first CMC denervation was less costly and more effective than trapeziectomy, supporting its cost-effectiveness for persistent first CMC arthritis after failed nonsurgical treatment.

LEVEL OF EVIDENCE: Level II economic.

CLINICAL RELEVANCE: Selective first CMC denervation may be offered as a cost-effective surgical option for patients with persistent symptomatic thumb CMC arthritis, providing comparable clinical outcomes to trapeziectomy at lower cost while preserving future reconstructive alternatives.