Lifetime cost-effectiveness of first metatarsophalangeal joint fusion using patient reported outcomes from National Foot and Ankle Registry data in the UK

Q2 Health Professions

Foot Pub Date : 2026-03-01 Epub Date: 2025-11-20 DOI:10.1016/j.foot.2025.102214

Craig Wyatt , Karan Malhotra , Joel Humphrey , Robert Clayton , David Townshend , Nilesh Makwana , Edward Wood , Lyndon Mason

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Abstract

Background

Hallux rigidus is a common and debilitating condition that increasingly impacts UK healthcare resources. First metatarsophalangeal joint (MTPJ) fusion is a widely performed intervention with excellent clinical outcomes; however, its commissioning has faced restrictions in some regions in the UK due to perceived limited value. Robust national cost-effectiveness evidence is needed to guide policy and ensure equitable access to care.

Methods

A cost–utility analysis was conducted using British Orthopaedic Foot & Ankle Society (BOFAS) Registry data for patients undergoing primary 1st MTPJ fusion. EuroQol-5 Dimension (EQ-5D-5L) outcomes at baseline and 1 year were utilised to estimate quality-adjusted life year (QALY) gains. A lifetime Markov model over 20 years simulated costs, utilities, and complication pathways from the UK NHS perspective. Costs were derived from national tariffs and discounted at 3.5 % per annum. Incremental cost-effectiveness ratios (ICERs) were calculated relative to conservative management, and deterministic sensitivity analysis tested uncertainty across cost and utility assumptions.

Results

Out of 1199 patients, 202 had completed full PROM datasets for cost-utility modelling. EQ-5D-5L improved from 0.53 pre-operatively to 0.77 at one year (p < 0.001), exceeding the MCID by six months and sustained thereafter. The base-case model demonstrated a discounted lifetime QALY gain of 3.331 and cost of £ 4698.15, yielding an ICER of £ 1410.58 per QALY gained. Across all sensitivity scenarios, including increased costs, reduced utility gains, and shortened duration of benefit, the ICER remained well below accepted NICE thresholds (£20,000–£30,000/QALY). In the low-cost scenario, 1st MTPJ fusion became cost-saving (negative ICER) by year 18.

Conclusion

1st MTPJ fusion is a highly cost-effective intervention for hallux rigidus, delivering clinically significant and durable improvements in quality of life at very low cost per QALY gained. This procedure provides greater value for money than many widely commissioned major orthopaedic operations, including hip and knee arthroplasty. Current NHS restrictions on access are not supported by health-economic evidence. These findings reinforce the essential role of 1st MTPJ fusion in value-based foot and ankle surgical care.

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使用来自英国国家足踝注册数据的患者报告结果，首次跖趾趾关节融合的终生成本效益。

背景：拇僵直是一种常见和衰弱的条件，越来越多地影响英国医疗保健资源。第一跖趾趾关节（MTPJ）融合是一种广泛应用的干预措施，具有良好的临床效果；然而，在英国的一些地区，由于价值有限，它的运行受到了限制。需要强有力的国家成本效益证据来指导政策和确保公平获得医疗服务。方法：使用英国骨科足踝协会（BOFAS）注册数据对首次行MTPJ融合的患者进行成本-效用分析。基线和1年的EuroQol-5维度（EQ-5D-5L）结果用于估计质量调整生命年（QALY）收益。一个超过20年的终身马尔可夫模型从英国NHS的角度模拟了成本、效用和并发症途径。成本来自国家关税，并以每年3.5% %的折扣计算。计算了相对于保守管理的增量成本-效果比（ICERs），确定性敏感性分析测试了成本和效用假设的不确定性。结果：在1199例患者中，202例完成了完整的PROM数据集，用于成本-效用模型。EQ-5D-5L从术前的0.53提高到一年后的0.77 （p ）结论：第一次MTPJ融合是一种高成本效益的治疗拇趾僵硬的干预措施，以极低的成本获得的每QALY提供临床显著和持久的生活质量改善。这种手术比许多广泛委托的主要矫形手术（包括髋关节和膝关节置换术）更物有所值。目前NHS对获取的限制没有健康经济证据的支持。这些发现加强了第1 MTPJ融合在基于价值的足踝外科护理中的重要作用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Foot Health Professions-Podiatry

CiteScore

2.00

自引率

0.00%

发文量

期刊介绍： The Foot is an international peer-reviewed journal covering all aspects of scientific approaches and medical and surgical treatment of the foot. The Foot aims to provide a multidisciplinary platform for all specialties involved in treating disorders of the foot. At present it is the only journal which provides this inter-disciplinary opportunity. Primary research papers cover a wide range of disorders of the foot and their treatment, including diabetes, vascular disease, neurological, dermatological and infectious conditions, sports injuries, biomechanics, bioengineering, orthoses and prostheses.