Selective First Carpometacarpal Denervation Is Cost-Effective Compared With Trapeziectomy for Thumb Carpometacarpal Arthritis.
- 1Department of Orthopaedic Surgery, University of Rochester School of Medicine, Rochester, NY.
Abstract
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.
Related
- GRIT Score Does Not Correlate With QuickDASH Scores in Patients Who Undergo Carpometacarpal Arthroplasty for Thumb Carpometacarpal Arthritis
- A Comparative Analysis of Surgical Treatment for First Carpometacarpal Osteoarthritis: A Systematic Review and Pooled Analysis of Randomized Controlled Trials
- Single-Ball Versus Double-Ball Flexor Carpi Radialis Interposition Arthroplasty Following Trapeziectomy: A Retrospective Radiological Study
- Pilot Study: Changes in Metacarpophalangeal Joint Loading After First Metacarpal Osteotomy for Thumb Carpometacarpal Osteoarthritis.
- Case report: surgical total cardiac denervation for refractory vasospastic angina: first report with pre- and post-operative autonomic assessment
BibTeX
@article{dussik2026selective,
title = {{Selective First Carpometacarpal Denervation Is Cost-Effective Compared With Trapeziectomy for Thumb Carpometacarpal Arthritis.}},
author = {Christopher M Dussik and Carlos Ortiz-Babilonia and Amy Phan and Daniel Yang and Joseph Ferraro},
journal = {Journal of hand surgery global online},
year = {2026},
month = oct,
doi = {10.1016/j.jhsg.2026.101164},
url = {https://europepmc.org/article/MED/42899137},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Selective First Carpometacarpal Denervation Is Cost-Effective Compared With Trapeziectomy for Thumb Carpometacarpal Arthritis.
AU - Christopher M Dussik
AU - Carlos Ortiz-Babilonia
AU - Amy Phan
AU - Daniel Yang
AU - Joseph Ferraro
PY - 2026
DA - 2026/10/12
JO - Journal of hand surgery global online
DO - 10.1016/j.jhsg.2026.101164
UR - https://europepmc.org/article/MED/42899137
AB - 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.
SN - 2589-5141
ER -