Abstract：
Background: Thumb carpometacarpal joint (CMC) osteoarthritis is the most symptomatic hand arthritis but the long-term healthcare burden for managing this condition is unknown. We sought to compare total healthcare cost and utilisation for operative and nonoperative treatments of thumb CMC arthritis. Methods: We conducted a retrospective longitudinal analysis using a large nationwide insurance claims database. A total of 18,705 patients underwent CMC arthroplasty (trapeziectomy with or without ligament reconstruction tendon interposition) or steroid injections between 1 October 2015 and 31 December 2018. Primary outcomes, healthcare utilisation and costs were measured from 1 year pre-intervention to 3 years post-intervention. Generalised linear mixed effect models adjusted for potentially confounding factors such as the Elixhauser comorbidity score with propensity score matching were applied to evaluate the association between the primary outcomes and treatment type. Results: A total of 13,646 patients underwent treatment through steroid injections, and 5,059 patients underwent CMC arthroplasty. At 1 year preoperatively, the surgery group required $635 more healthcare costs (95% CI [594.28, 675.27]; p < 0.001) and consumed 42% more healthcare utilisation (95% CI [1.38, 1.46]; p < 0.0001) than the steroid injection group. At 3 years postoperatively, the surgery group required $846 less healthcare costs (95% CI [-883.07, -808.51], p < 0.0001) and had 51% less utilisation (95% CI [0.49, 0.53]; p < 0.0001) annually. Cumulatively over 3 years, the surgical group on average was $4,204 costlier than its counterpart secondary to surgical costs. Conclusions: CMC arthritis treatment incurs high healthcare cost and utilisation independent of other medical comorbidities. At 3 years postoperatively, the annual healthcare cost and utilisation for surgical patients were less than those for patients who underwent conservative management, but this difference was insufficient to offset the initial surgical cost. Level of Evidence: Level III (Therapeutic).
摘要：
背景：拇指腕掌关节（CMC）骨关节炎是最有症状的手关节炎，但治疗这种疾病的长期医疗负担尚不清楚。我们试图比较拇指CMC关节炎的手术和非手术治疗的总医疗保健成本和利用率。方法：我们使用全国大型保险索赔数据库进行了回顾性纵向分析。2015年10月1日至2018年12月31日期间，共有18,705例患者接受了CMC关节成形术（带或不带韧带重建肌腱插入的梯形切除术）或类固醇注射。主要结果,从干预前1年到干预后3年,对医疗服务利用率和费用进行了测量.应用针对潜在混杂因素调整的广义线性混合效应模型，如Elixhauser合并症评分与倾向评分匹配，以评估主要结局与治疗类型之间的关联。结果：共有13,646例患者接受了类固醇注射治疗，5,059例患者接受了CMC关节置换术。术前1年，与类固醇注射组相比,手术组需要的医疗费用增加635美元(95%CI[594.28,675.27];p<0.001),医疗利用率增加42%(95%CI[1.38,1.46];p<0.0001).术后3年，手术组需要减少846美元的医疗费用(95%CI[-883.07，-808.51]，p<0.0001)，每年利用率降低51%(95%CI[0.49，0.53]；p<0.0001)。累计超过3年，手术组的平均费用比手术费用低4,204元。结论：CMC关节炎治疗会产生高昂的医疗保健成本和利用率，而与其他医疗合并症无关。术后3年，手术患者的年度医疗费用和利用率低于接受保守治疗的患者，但这一差异不足以抵消初始手术费用.证据级别：III级（治疗）。
