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Cost minimisation using clinic-based treatment for common hand conditions--a prospective economic analysis.

INTRODUCTION
The purpose of this study was to compare the cost of treatment of Dupuytren's disease, ganglia and trigger digits in the out-patient department with the operating theatre.


PATIENTS AND METHODS
All patients seen in a new patient hand clinic with a diagnosis of Dupuytren's disease, trigger digit or ganglion of the wrist or hand requiring treatment were prospectively identified over a 6-month period. The numbers undergoing a procedure in the out-patient clinic or theatre were recorded. Costings of theatre time and out-patient time, as well as national tariff income, were obtained from the hospital management.


RESULTS
Over the 6-month period, 80, 26, and 52 patients were treated with regard to Dupuytren's disease, ganglia and trigger digits, respectively. Of these, 37, 23, and 44 were treated by an out-patient procedure, and 43, 3 and 8 underwent a formal operation. The total cost of the out-patient procedures was calculated at pound 1560 over 6 months. To perform these as formal operations would have cost pound 64,896. The cost savings were, therefore, pound 63,336, or pound 126,672 per annum.


CONCLUSIONS
Out-patient interventions for Dupuytren's disease, ganglia and trigger digits result in significant cost savings over formal surgical treatment.