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Estimated annual cost of amyloid screening at a single practice
Richard W McKinney, MD
1,2, Jeremiah A. Adams, BS
3, Pedro K Beredjiklian, MD
4, Christopher Jones, MD
5; Jonas Matzon, MD
6(1)Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, (2)Allegheny Health Network, Pittsburgh, PA, (3)Roth, Philadelphia, PA, (4)Rothman Orthopaedic Institute, Philadelphia, PA, (5)Orthopaedics, Rothman Orthopaedic Institute, Philadelphia, PA, (6)Rothman Orthopaedics, Sewell, NJ
Introduction: Amyloidosis is a systemic condition in which misfolded proteins deposit in the soft tissues with clinical manifestations of carpal tunnel syndrome (CTS), trigger finger (TF), and heart disease, among others. Cardiac involvement is associated with poor prognosis, but CTS and TF may predate these findings. Hand surgeons are in prime position to detect the disease early and initiate care. Studies have shown the prevalence of amyloidosis in patients with CTS and TF and have proposed screening protocols. Cardiology literature has questioned the cost effectiveness of amyloidosis treatment. Cost concerns related to screening have been raised. Our aim is to estimate the annual cost of adopting an amyloidosis screening protocol in surgical patients with CTS and TF at a single orthopedic practice. Given the prevalence of CTS and TF, we hypothesize that the costs would be substantial.
Materials & Methods: Using described screening criteria (Table 1), a database query output the number of patients qualifying for biopsy over a one-year period (2024) at a single orthopaedic practice with 16 hand surgeons. We established 4 cohorts with progressively inclusive screening criteria. Initial screening costs assumed all patients underwent biopsy and Congo red staining. Based on published data, we estimated positive amyloid screening rates of 2% (minimum), 65% (maximum), and 17% (mean). This yielded the number of patients requiring amyloid subtyping and further testing. Cost information was obtained from departmental billing managers and from publicly available data (Table 2). These costs were then combined to give an estimated cost associated with the screening protocol.
Results: Over the one-year period, 1501 patients met established inclusion criteria (Cohort 1). With emerging screening criteria, the number of patients increased to 1679, 1898, and 1981 (Cohorts 2-4, respectively). The cost for initial screening ranged from $255,170 to $336,770. The cost for subsequent subtyping and other testing ranged from $302,635 to $12,993,125. Using mean biopsy positive rates, this range was $2,572,397 - $3,399,599. The total annual cost for all recommended screening was between $557,805 and $13,329,895. Using mean biopsy positive rates, this range was $2,827,567 - $3,736,369.
Conclusions:The estimated annual cost of amyloidosis screening in a single orthopedic practice would be between $557,805 and $13,329,895.
Assuming an amyloid positive biopsy rate of 17% (mean), the cost would range from $2,827,567 to $3,736,369.
Future research is needed to better characterize patients at risk for amyloidosis and to determine the cost effectiveness of routine amyloidosis screening
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