Download PDF
J Reconstr Microsurg
DOI: 10.1055/a-2273-3940
Original Article

Economic Cost-Benefit Analysis of Nerve Implanted into Muscle versus Targeted Muscle Reinnervation versus Regenerative Peripheral Nerve Interface, for Treatment of the Painful Neuroma

Zachary Zamore
1   Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
,
Pooja S. Yesantharao
1   Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
2   Department of Surgery, Division of Plastic & Reconstructive Surgery, Stanford University School of Medicine, Palo Alto, CA
,
Pathik Aravind
1   Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
,
A. Lee Dellon
1   Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
› Author Affiliations Funding None.
› Further Information
    Permissions and Reprints

Abstract

Background This study investigated the relative cost utility of three techniques for the management of symptomatic neuromas after neuroma excision: (1) implantation of nerve into muscle, (2) targeted muscle reinnervation (TMR), and (3) regenerative peripheral nerve interface (RPNI).

Methods The costs associated with each procedure were determined using Common Procedural Terminology codes in combination with data from the Centers for Medicaid and Medicare Services Physician and Facility 2020 Fee Schedules. The relative utility of the three procedures investigated was determined using changes in Patient-Reported Outcomes Measurement Information System (PROMIS) and Numeric Rating Scale (NRS) pain scores as reported per procedure. The relative utility of each procedure was reported in terms of quality-adjusted life years (QALYs), as is standard in the literature.

Results The least expensive option for the surgical treatment of painful neuromas was nerve implantation into an adjacent muscle. In contrast, for the treatment of four neuromas, as is common postamputation, TMR without a microscope was found to cost $50,061.55 per QALY gained, TMR with a microscope was found to cost $51,996.80 per QALY gained, and RPNI was found to cost $14,069.28 per QALY gained. While RPNI was more expensive than nerve implantation into muscle, it was still below the standard willingness-to-pay threshold of $50,000 per QALY, while TMR was not.

Conclusion Evaluation of costs and utilities associated with the various surgical options for the management of painful neuromas suggest that nerve implantation into muscle is the least expensive option with the best improvement in QALY, while demonstrating comparable outcomes to TMR and RPNI with regard to pain symptoms.

Keywords

neuroma - TMR - RPNI - cost utility

Presented at

N/A




Publication History

Received: 07 November 2023

Accepted: 15 February 2024

Accepted Manuscript online:
21 February 2024

Article published online:
26 March 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Poppler LH, Parikh RP, Bichanich MJ. et al. Surgical interventions for the treatment of painful neuroma: a comparative meta-analysis. Pain 2018; 159 (02) 214-223
    CrossrefPubMedGoogle Scholar
  • 2 Kim PS, Ko JH, O'Shaughnessy KK, Kuiken TA, Pohlmeyer EA, Dumanian GA. The effects of targeted muscle reinnervation on neuromas in a rabbit rectus abdominis flap model. J Hand Surg Am 2012; 37 (08) 1609-1616
    CrossrefPubMedGoogle Scholar
  • 3 Souza JM, Cheesborough JE, Ko JH, Cho MS, Kuiken TA, Dumanian GA. Targeted muscle reinnervation: a novel approach to postamputation neuroma pain. Clin Orthop Relat Res 2014; 472 (10) 2984-2990
    CrossrefPubMedGoogle Scholar
  • 4 Dumanian GA, Potter BK, Mioton LM. et al. Targeted muscle reinnervation treats neuroma and phantom pain in major limb amputees: a randomized clinical trial. Ann Surg 2019; 270 (02) 238-246
    CrossrefPubMedGoogle Scholar
  • 5 Woo SL, Kung TA, Brown DL, Leonard JA, Kelly BM, Cederna PS. Regenerative peripheral nerve interfaces for the treatment of postamputation neuroma pain: a pilot study. Plast Reconstr Surg Glob Open 2016; 4 (12) e1038
    CrossrefPubMedGoogle Scholar
  • 6 Kubiak CA, Kemp SWP, Cederna PS, Kung TA. Prophylactic regenerative peripheral nerve interfaces to prevent postamputation pain. Plast Reconstr Surg 2019; 144 (03) 421e-430e
    CrossrefPubMedGoogle Scholar
  • 7 PSRC/PSF Mini Meeting Session II. Nerve Smackdown. PSRC: Plastic Surgery Research Council. Accessed March 1, 2024 at: https://www.youtube.com/watch?v=v0WrdDP1Bkw&feature=youtu.be
    PubMedGoogle Scholar
  • 8 WWE SmackDown. Accessed March 1, 2024 at: https://en.wikipedia.org/w/index.php?title=WWE_SmackDown&oldid=1193250662
    PubMed
  • 9 Childers CP, Maggard-Gibbons M. Understanding costs of care in the operating room. JAMA Surg 2018; 153 (04) e176233
    CrossrefPubMedGoogle Scholar
  • 10 Craig BM, Reeve BB, Brown PM. et al. US valuation of health outcomes measured using the PROMIS-29. Value Health 2014; 17 (08) 846-853
    CrossrefPubMedGoogle Scholar
  • 11 Stone PW, Chapman RH, Sandberg EA, Liljas B, Neumann PJ. Measuring costs in cost-utility analyses. Variations in the literature. Int J Technol Assess Health Care 2000; 16 (01) 111-124
    CrossrefPubMedGoogle Scholar
  • 12 Domeshek LF, Krauss EM, Snyder-Warwick AK. et al. Surgical treatment of neuromas improves patient-reported pain, depression, and quality of life. Plast Reconstr Surg 2017; 139 (02) 407-418
    CrossrefPubMedGoogle Scholar
  • 13 Owens DK, Qaseem A, Chou R, Shekelle P. Clinical Guidelines Committee of the American College of Physicians. High-value, cost-conscious health care: concepts for clinicians to evaluate the benefits, harms, and costs of medical interventions. Ann Intern Med 2011; 154 (03) 174-180
    CrossrefPubMedGoogle Scholar
  • 14 Walsh AR, Lu J, Rodriguez E, Diamond S, Sultan SM. The current state of targeted muscle reinnervation: a systematic review. J Reconstr Microsurg 2023; 39 (03) 238-244
    Article in Thieme ConnectPubMedGoogle Scholar
  • 15 Chang BL, Hill AL, Mondshine J. et al. Primary targeted muscle reinnervation in above-knee amputations in patients with unsalvageable limbs from limb-threatening ischemia or infection. J Reconstr Microsurg 2024; 40 (02) 109-117
    Article in Thieme ConnectPubMedGoogle Scholar