■非手术治疗与内侧尺侧副韧带(MUCL)部分撕裂的早期重建仍存在争议,对于部分眼泪,最常见的治疗选择包括休息,康复,富血小板血浆(PRP),和/或手术干预。然而,MUCL重建术(UCLR)或一系列PRP注射的非手术治疗等治疗结果的改善是否证明其增加的前期费用是合理的,目前尚不清楚.
■为了比较单独物理治疗的初始试验的成本效益,物理治疗加上一系列PRP注射的初步试验,和早期UCLR,以确定针对年轻人的首选具有成本效益的治疗策略,高水平的棒球投手,MUCL的部分眼泪,并渴望继续在下一个级别比赛(即,大学和/或专业)。
■经济和决策分析;证据水平,2.
■开发了马尔可夫链蒙特卡罗概率模型来评估1000名年轻人的结果和成本,高层,模拟投手在有或没有PRP的情况下进行非手术治疗,与早期UCLR进行部分MUCL撕裂。效用值,返回播放率,和转移概率是从出版的文献中得出的。费用是根据作者机构接受每种治疗策略的典型患者确定的。成果措施包括成本,获得的游戏年限(PYs),和增量成本效益比(ICER)。
■没有PRP的非手术管理产生的平均总成本,PRP非手术管理,和早期UCLR分别为22,520美元、24,800美元和43,992美元。平均而言,相对于非手术管理,早期的UCLR在10年的时间范围内产生了额外的4.0个PYs,导致ICER为5395美元/日元,远低于5万美元的支付意愿门槛。总的来说,早期的UCLR被确定为在微观模拟模型中包含的77.5%投手的首选成本效益策略,在15%的投手中,PRP的非手术管理被确定为首选策略,而在7.5%的投手中,仅非手术管理。
■尽管前期成本增加,与大多数高级棒球投手的非手术管理的初始试验相比,UCLR是MUCL部分眼泪的更具成本效益的治疗选择。
UNASSIGNED: Nonoperative management versus early reconstruction for partial tears of the medial ulnar collateral ligament (MUCL) remains controversial, with the most common treatment options for partial tears consisting of rest, rehabilitation, platelet-rich plasma (PRP), and/or surgical intervention. However, whether the improved outcomes reported for treatments such as MUCL reconstruction (UCLR) or nonoperative management with a series of PRP injections justifies their increased upfront costs remains unknown.
UNASSIGNED: To compare the cost-effectiveness of an initial trial of physical therapy alone, an initial trial of physical therapy plus a series of PRP injections, and early UCLR to determine the preferred cost-effective treatment strategy for young, high-level baseball pitchers with partial tears of the MUCL and with aspirations to continue play at the next level (ie, collegiate and/or professional).
UNASSIGNED: Economic and decision analysis; Level of evidence, 2.
UNASSIGNED: A Markov chain Monte Carlo probabilistic model was developed to evaluate the outcomes and costs of 1000 young, high-level, simulated pitchers undergoing nonoperative management with and without PRP versus early UCLR for partial MUCL tears. Utility values, return to play rates, and transition probabilities were derived from the published literature. Costs were determined based on the typical patient undergoing each treatment strategy at the authors\' institution. Outcome measures included costs, acquired playing years (PYs), and the incremental cost-effectiveness ratio (ICER).
UNASSIGNED: The mean total costs resulting from nonoperative management without PRP, nonoperative management with PRP, and early UCLR were $22,520, $24,800, and $43,992, respectively. On average, early UCLR produced an additional 4.0 PYs over the 10-year time horizon relative to nonoperative management, resulting in an ICER of $5395/PY, which falls well below the $50,000 willingness-to-pay threshold. Overall, early UCLR was determined to be the preferred cost-effective strategy in 77.5% of pitchers included in the microsimulation model, with nonoperative management with PRP determined to be the preferred strategy in 15% of pitchers and nonoperative management alone in 7.5% of pitchers.
UNASSIGNED: Despite increased upfront costs, UCLR is a more cost-effective treatment option for partial tears of the MUCL than an initial trial of nonoperative management for most high-level baseball pitchers.