Comparing Nerve Transfer Versus Tendon Transfer and Conservative Management for Restoring Finger Extension Following Tetraplegia: A Cost-Effectiveness Analysis

Background/Objectives: Cervical spinal cord injury (SCI) frequently causes tetraplegia and severe upper-limb dysfunction with substantial societal cost. Restoring finger extension is a priority, since even modest gains improve independence. Tendon transfer and supinator-to-posterior interosseous nerve transfer (SUP–PIN) both restore hand function, but their relative economic value is unclear. We assessed the lifetime cost-effectiveness of SUP–PIN versus tendon transfer and conservative management for finger extension in patients with mid-cervical SCIs who are candidates for both reconstructive strategies.

Methods

A decision-analytic model combining a decision-tree front end with a lifetime Markov state-transition structure (one-year cycles, 3% annual discounting, half-cycle correction) compared SUP–PIN, tendon transfer, and conservative (nonoperative) care over a lifetime horizon, incorporating direct medical costs and indirect productivity losses. The outcomes were quality-adjusted life years (QALYs) accumulated over the horizon, using a willingness-to-pay threshold of $100,000/QALY. Success, complication, recovery, and return-to-work probabilities were drawn from the published literature. Deterministic, probabilistic, and two-way sensitivity analyses assessed robustness.