Background:Nonoperative management versus early reconstruction for partial tears of the medial ulnar collateral ligament (MUCL) remains controversial, with the most common treatment options for partial tears consisting of rest, rehabilitation, platelet-rich plasma (PRP), and/or surgical intervention. However, whether the improved outcomes reported for treatments such as MUCL reconstruction (UCLR) or nonoperative management with a series of PRP injections justifies their increased upfront costs remains unknown.Purpose:To compare the cost-effectiveness of an initial trial of physical therapy alone, an initial trial of physical therapy plus a series of PRP injections, and early UCLR to determine the preferred cost-effective treatment strategy for young, high-level baseball pitchers with partial tears of the MUCL and with aspirations to continue play at the next level (ie, collegiate and/or professional).Study Design:Economic and decision analysis; Level of evidence, 2.Methods:A Markov chain Monte Carlo probabilistic model was developed to evaluate the outcomes and costs of 1000 young, high-level, simulated pitchers undergoing nonoperative management with and without PRP versus early UCLR for partial MUCL tears. Utility values, return to play rates, and transition probabilities were derived from the published literature. Costs were determined based on the typical patient undergoing each treatment strategy at the authors’ institution. Outcome measures included costs, acquired playing years (PYs), and the incremental cost-effectiveness ratio (ICER).Results:The mean total costs resulting from nonoperative management without PRP, nonoperative management with PRP, and early UCLR were $22,520, $24,800, and $43,992, respectively. On average, early UCLR produced an additional 4.0 PYs over the 10-year time horizon relative to nonoperative management, resulting in an ICER of $5395/PY, which falls well below the $50,000 willingness-to-pay threshold. Overall, early UCLR was determined to be the preferred cost-effective strategy in 77.5% of pitchers included in the microsimulation model, with nonoperative management with PRP determined to be the preferred strategy in 15% of pitchers and nonoperative management alone in 7.5% of pitchers.Conclusion:Despite increased upfront costs, UCLR is a more cost-effective treatment option for partial tears of the MUCL than an initial trial of nonoperative management for most high-level baseball pitchers.

中文翻译：

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对于高水平棒球投手来说，早期手术治疗尺侧副韧带部分撕裂可能比非手术治疗更具成本效益，并且可以延长职业生涯：基于决策分析马尔可夫模型的分析


背景：内侧尺侧副韧带（MUCL）部分撕裂的非手术治疗与早期重建仍然存在争议，部分撕裂最常见的治疗选择包括休息、康复、富血小板血浆（PRP）和/或手术干预。然而，MUCL 重建 (UCLR) 或一系列 PRP 注射非手术治疗等治疗方法所报告的改善结果是否证明其前期成本增加是合理的仍然未知。 目的：比较单独物理治疗的初始试验的成本效益，物理治疗的初步试验加上一系列 PRP 注射和早期 UCLR，以确定对于 MUCL 部分撕裂并渴望继续参加下一个级别比赛的年轻高水平棒球投手的首选经济有效的治疗策略（即大学和/或专业）。研究设计：经济和决策分析；证据水平，2.方法：开发了马尔可夫链蒙特卡罗概率模型来评估 1000 名年轻、高水平、模拟投手接受非手术治疗（有或没有 PRP）与早期 UCLR 部分 MUCL 撕裂的结果和成本。效用值、游戏回报率和转换概率均来自已发表的文献。费用是根据作者所在机构接受每种治疗策略的典型患者确定的。结果指标包括成本、获得的比赛年数 (PY) 和增量成本效益比 (ICER)。结果：不使用 PRP 的非手术治疗、使用 PRP 的非手术治疗和早期 UCLR 产生的平均总成本分别为 22,520 美元、24,800 美元和 24,800 美元。分别为 43,992 美元。平均而言，早期的加州大学洛杉矶分校 (UCLR) 额外产出了 4 个。相对于非手术治疗，10 年时间范围内的 PY 为 0，导致 ICER 为 5395 美元/PY，远低于 50,000 美元的支付意愿阈值。总体而言，早期 UCLR 被确定为微观模拟模型中 77.5% 投手的首选经济有效策略，PRP 非手术治疗被确定为 15% 投手的首选策略，单独非手术治疗为 7.5% 的投手的首选策略结论：尽管前期成本增加，但对于大多数高水平棒球投手来说，与非手​​术治疗的初步试验相比，UCLR 对于 MUCL 部分撕裂来说是一种更具成本效益的治疗选择。