The Plastic Surgery Foundation
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Grants We Funded

In 2017, The Plastic Surgery Foundation (The PSF) awarded 27 Investigator-Initiated projects and allocated $809,578 to support the newest, clinically relevant research in plastic surgery.

The American Society of Plastic Surgeons/PSF leadership is committed to continuing to provide high levels of investigator initiated research support to ensure that plastic surgeons have the needed research resources to be pioneers and innovators in advancing the practice of medicine.

Research Abstracts

Search The PSF database to have easy access to full text grant abstracts from past PSF-funded research projects 2003 to present. All abstracts are the work of the Principal Investigators and were retrieved from their PSF grant applications. Several different filters may be applied to locate abstracts specific to a particular focus area, or PSF funding mechanism.

A Cost-Utility Analysis of Total Wrist Arthroplasty and Total Wrist Fusion

Principal Investigator
Christi Cavaliere MD

Year
2009

Institution
University of Michigan

Funding Mechanism
Scientific Essay Contest

Focus Area


Abstract
Background: Management of end stage rheumatoid wrist disease remains controversial. Total wrist fusion (TWF) provides reliable pain relief and stability and is the most commonly applied management strategy. Total wrist arthroplasty (TWA) is a motion-preserving alternative that is gaining popularity. The purpose of this study is to perform a cost - utility analysis comparing TWA to TWF for the rheumatoid wrist Methods: A time trade-off utility survey was developed to investigate patient and physician preferences for the potential outcomes of TWA and TWF. The study sample consisted of rheumatoid patients (N=49) recruited as part of an ongoing NIH study and a national random sample of hand surgeons and rheumatologists (N=-109). A decision tree was created using utility values derived from the survey, and the expected quality-adjusted-life-years (QALYs) for each procedure were determined. Using the societal perspective, we derive the costs based on the Medicare fee schedules for the CPT codes associated with TWA and TWF and their potential complications. Costs per QALY were calculated and compared. Results: Patients and physicians both showed a preference for operative management over nonoperative management. Application of cost data indicated that the incremental cost per additional QALY gained for TWA over non-operative management was $841 - $960 and the incremental cost per QALY gained over TWF was $458 - $1,820, which is substantially less than the national standard of $50,000/QALY deemed acceptable for adoption. Conclusion: In the absence of rigorous outcome data, a cost-utility analysis is useful to guide treatment decisions. TWA and TWF are both extremely cost-effective procedures. This study incorporated patient and physician utilities to demonstrate that TWA has a small incremental cost over the TWF procedure, and TWA is worthy of adoption based on this economic model.

Biography
Clinical Research Junior Category - Christi Cavaliere completed her plastic surgery training at the University of Michigan in 2006. She was then awarded a research fellowship through the Robert Wood Johnson Clinical Scholars Program at the University of Michigan. The focus of her research has been management of rheumatoid wrist disease. Following her research fellowship she moved to California where she is in practice at the VA Northern California Health System at Martinez.