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Contrasting Medical Environments: An Analysis of Trigger Finger Release to Maximize Value
Hunter Cohn, B.A.
1; Alex Lindahl, BS
2; Reid Becker, BS
1; Emily Mazier, B.S.
2; Charles S Day, MD, MBA
31Wayne State University School of Medicine, Detroit, MI; 2Oakland University William Beaumont School of Medicine, Rochester, MI; 3Henry Ford Health System, Detroit, MI
Introduction: With rising healthcare costs, it is essential to optimize quantifying cost-effective care. This study compares the value of trigger finger release (TFR) performed in a hospital outpatient department (HOPD), procedure room (PR), and ambulatory surgical center (ASC). We hypothesize that the PR will generate the greatest value. Methods: Our costing methodology is outlined in Figure 1. Differences in pre-operative and 3-month post-operative PROMIS Pain Interference (PI) and Upper Extremity (UE) scores were multiplied by average life-years remaining for each patient to calculate PROMIS-adjusted life-years (PALYs). Costs were divided by PALY to determine the average cost-effectiveness ratio (ACER). Differences in costs and outcomes were assessed using two-tailed t-tests. Results: Costs, PALYs, and ACERs are represented in Figure 2. Total costs were greatest in the HOPD and comparably less in the ASC (p=0.137) and significantly less in the PR (p=0.008). PALYs were comparable between locations with the ASC having the greatest reduction in PI scores. The ACERs indicate that TFR in the ASC is less costly to achieve similar outcomes as the HOPD. ACERPI was greatest in the PR, attributable to a poorer improvement in pain following surgery. ACERUE, however, was lowest in the PR followed by the ASC and HOPD. Conclusion: PR is the least costly site for performing TFR. Similar outcomes across settings suggest that cost is the major driver in TFR value. ASC generated greater value than HOPD as indicated by lower ACERPI and ACERUE. Meanwhile, PR ACERs indicate that the PR is the most valuable when considering UE but least valuable for PI. Implementing cost-effective strategies like electing more valuable surgical sites for procedures is critical to ameliorating rising healthcare costs. 
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