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Economic Analysis of Revision Amputation and Replantation Treatment of Finger Amputation Injuries

Sears, Erika Davis M.D., M.S.; Shin, Ryan B.S., M.P.H.; Prosser, Lisa A. Ph.D.; Chung, Kevin C. M.D., M.S.

Plastic and Reconstructive Surgery: April 2014 - Volume 133 - Issue 4 - p 827–840
doi: 10.1097/PRS.0000000000000019
Hand/Peripheral Nerve: Outcomes Articles
Coding Perspective

Background: The purpose of this study was to perform a cost-utility analysis to compare revision amputation and replantation treatment of finger amputation injuries across a spectrum of injury scenarios.

Methods: The study was conducted from the societal perspective. Decision tree models were created for the reference case (two-finger amputation injury) and seven additional injury scenarios for comparison. Inputs included cost, quality of life, and probability of each health state. A Web-based time trade-off survey was created to determine quality-adjusted life-years for health states; 685 nationally representative adult community members were invited to participate in the survey. Overall cost and quality-adjusted life-years for revision amputation and replantation were calculated for each decision tree. An incremental cost-effectiveness ratio was calculated if a treatment was more costly but more effective.

Results: The authors had a 64 percent response rate (n = 437). Replantation treatment had greater costs and quality-adjusted life-years compared with revision amputation in all injury scenarios. Replantation of single-digit injuries had the highest incremental cost-effectiveness ratio ($136,400 per quality-adjusted life-year gained). Replantation of three- and four-digit amputation injuries had relatively low cost-to-benefit ratios ($27,100 and $23,800 per quality-adjusted life-year, respectively). Replantation for distal thumb amputation had a relatively low incremental cost-effectiveness ratio ($26,300 per quality-adjusted life-year) compared with replantation of nonthumb distal amputations ($60,200 per quality-adjusted life-year).

Conclusions: The relative cost per quality-adjusted life-year gained with replantation treatment varied greatly among the injury scenarios. Situations in which indications for replantation are debated had higher cost per quality-adjusted life-year gained. This study highlights variability in value for replantation among different injury scenarios.

Supplemental Digital Content is available in the text.Coding Perspective for this article is on page 836.

Ann Arbor, Mich.

From the Section of Plastic Surgery, Department of Surgery, and the Department of Pediatrics and Communicable Diseases, University of Michigan Health System; and the Veterans Administration Health System.

Received for publication July 28, 2013; accepted September 23, 2013.

Presented at the 92nd Annual Meeting of the American Association of Plastic Surgeons, in New Orleans, Louisiana, April 20 through 23, 2013.

Disclosure: None of the authors has a financial interest to declare in relation to the content of this article.

Supplemental digital content is available for this article. Direct URL citations appear in the text; simply type the URL address into any Web browser to access this content. Clickable links to the material are provided in the HTML text of this article on the Journal’s Web site (

This work was supported by the Plastic Surgery Foundation.

Kevin C. Chung, M.D., M.S., Section of Plastic Surgery, University of Michigan Health System, 1500 East Medical Center Drive, 2130 Taubman Center, SPC 5340, Ann Arbor, Mich. 48109-5340,

©2014American Society of Plastic Surgeons