Minimizing Costs for Dorsal Wrist Ganglion Treatment: A Cost-Minimization Analysis

Purpose Dorsal wrist ganglions are treated commonly with aspiration, or open or arthroscopic excision in operating room (OR) or procedure room (PR) settings. As it remains unclear which treatment strategy is most cost-effective in yielding cyst resolution, our purpose was to perform a formal cost-minimization analysis from the societal perspective in this context.Methods A microsimulation decision analytic model evaluating 5 treatment strategies for dorsal wrist ganglions was developed, ending in either resolution or a single failed open revision surgical excision. Strategies included immediate open excision in the OR, immediate open excision in the PR, immediate arthroscopic excision in the OR, or 1 or 2 aspirations before each of the surgical options. Recurrence and complications rates were pooled from the literature for each treatment type. One-way sensitivity and threshold analyses were performed.Results The most cost-minimal strategy was 2 aspiration attempts before open surgical excision in the PR setting ($1,603 & PLUSMN; 1,595 per resolved case), followed by 2 aspirations before open excision in the OR ($1,969 & PLUSMN; 2,165 per resolved case). Immediate arthroscopic excision was the costliest strategy ($6,539 & PLUSMN; 264 per resolved case). Single aspiration preoperatively was more cost-minimal than any form of immediate surgery ($2,918 & PLUSMN; 306 and $4,188 & PLUSMN; 306 per resolved case performed in the PR and OR, respectively).Conclusions From the societal perspective, performing 2 aspirations before surgical excision in the PR setting was the most cost-minimal treatment strategy, although in reference to surgeons who do not perform this procedure in the PR setting, open excision in the OR was nearly as cost-effective. As patient preferences may preclude routinely performing 2 aspirations, performing at least 1 aspiration before surgical excision improves the cost-effectiveness of dorsal wrist ganglions treatment.(J Hand Surg Am. 2023;48(1):9-18. Copyright & COPY; 2023 by the American Society for Surgery of the Hand. All rights reserved.)Type of study/level of evidence Economic Decision Analysis II.