Pulling the Trigger on Patient Care: A Comparison of ASC and HOPD Settings for Trigger Finger Release

Introduction There is an increased focus on balancing cost-effectiveness with positive patient outcomes. Trigger finger release (TFR) offers an opportunity to compare its value in a hospital outpatient department (HOPD) versus an ambulatory surgical center (ASC). We hypothesized that TFR performed in an ASC provides greater value. Methods Time-Driven Activity-Based Costing (TDABC) was used to collect cost data for each procedure. Steps in the patient care pathway were timed, and costs were categorized as: Direct Variable: Staff salaries, supplies Direct Fixed: Facility, utilities Indirect: Administration, marketing Changes in PROMIS Pain Interference (PI) and Upper Extremity (UE) from pre-operative to three months post-operative were multiplied by the average patient life-years to calculate productivity-adjusted life-years (PALYs) for each metric. Costs were divided by PALYs to determine average cost-effectiveness ratios (ACERUE and ACERPI) for both settings. Results Data from 33 patients (n=22 HOPD, n=11 ASC) showed the average cost for TFR was $4,683.10 in ASC and $3,842.79 in HOPD (p=0.319). ASC PALYUE (0.77) exceeded HOPD PALYUE (0.23, p=0.302). HOPD ACERUE was greater than ASC ($14924.63/PALY vs $6,888.59/PALY), as was ACERPI ($5887.70/PALY vs $5257.270/PALY). Discussion/Clinical Significance Our study found that procedures performed in an ASC generally outperformed those in a HOPD in costs, utility, and pain improvement. However, none of the differences were statistically significant (p>0.05). However, lower ACERs for PROMISUE and PROMISPI suggest that ASC may provide better value for eligible patients.