Author(s): Emmanuel P. Estrella, M.D.
The success of a finger replantation surgery is determined by many factors. The decision whether or not to replant an amputated part must be taken into consideration given the current economic situation in the country. The objective of this article was to determine the cost-effectiveness of replantation versus revision amputation surgery in a single digit amputation of the index finger at the level of the proximal phalanx.
Costing for the two modes of treatment up to return to work was taken on the prevailing costs of hospital admission in a charity service in a government tertiary hospital. Probabilities for events and outcomes for the two treatment modalities (replantation versus revision amputation) were determined through literature reviews and meta-analysis. Utilities were taken from disability adjusted life years (DALYs) recommended by the WHO on single digit amputations. A decision tree was constructed and a fold-back analysis was performed to determine optimal treatment. A 1-way sensitivity analysis was used to determine the effect on decision making of varying outcome probabilities and utilities. Finally, the cost-effectiveness ratio was determined to know which treatment modality was the most cost-effective.
The total costs (direct and indirect costs) for replantation and revision amputation surgery were PhP60,000.41 and PhP18,944.25, respectively. Using the decision analysis model and fold-back analysis, the expected value for the revision amputation surgery was higher (0.104) compared to replantation surgery (0.06). Measuring the cost-effectiveness of the two treatments, the replantation surgery cost-effectiveness ratio (CER) was 19,330.10 compared to only 4,700.80 for the revision amputation surgery. Thus, this analysis showed that the revision amputation was the optimal and most cost-effective treatment for single digit amputation of the index finger.
Revision amputation was the optimal strategy based on literature and expected utilities compared to replantation surgery in single digit amputation of the index finger. However, in the clinical setting, the need for the single digit outweighs the results of amputation surgery, thus individualized treatment should be exercised.
Key words: cost-effectiveness study, cost-analysis, revision amputation, digital replantation