3466. Diagnostic Workup of Ulnar Neuropathy at the Elbow (UNE): A Cost-Effectiveness Study
Authors * Denotes Presenting Author
  1. Meghan Jardon *; New York University Langone Medical Center
  2. Naveen Subhas; Cleveland Clinic Institute
  3. Darryl Sneag; Hospital for Special Surgery
  4. Zachary Li; New York University Langone Medical Center
  5. Laith Jazrawi; New York University Langone Medical Center
  6. Nader Paksima; New York University Langone Medical Center
  7. Soterios Gyftopoulos; New York University Langone Medical Center
There are multiple modalities available for diagnosing ulnar neuropathy at the elbow (UNE), including electrodiagnostic testing (EDX), ultrasound (US), and magnetic resonance imaging (MRI), with no clear consensus on the optimal diagnostic strategy. This study’s purpose was to determine the most cost-effective diagnostic strategy in suspected UNE.

Materials and Methods:
We developed a decision analytic model from the U.S. healthcare system perspective over a 1-year period. The hypothetical population comprised 55-year-old individuals with medial elbow pain and/or paresthesias radiating to the hand, without weakness. We utilized the decision model to compare differences in incremental cost-effectiveness and total net monetary benefits (NMB) of single modality strategies (EDX, US and MRI) and multimodality strategies, including combinations of US and MRI, EDX and US, and EDX and MRI. Input data for probabilities and utility values were obtained through a systematic Medline and Embase search of the literature, and costs were tabulated from Centers for Medicaid & Medicare Services. The primary effectiveness outcome was quality-adjusted life years (QALYs). Costs were estimated in 2023 U.S. dollars. Willingness to pay threshold was set at $100,000.

The strategy utilizing US first, followed by MRI, was the favored diagnostic strategy, as it had the highest total NMB ($92,667) and total QALYs (.935). EDX and US single-modality strategies were less favorable, with lower total NMB ($88,866 and $90,022 respectively), and total QALYs (.894 and .906, respectively). Other diagnostic strategies were ruled out by absolute or extended dominance. One-way sensitivity analysis found the model results sensitive to the utility of UNE recovery. Otherwise, the model results remained robust and did not change over a range of costs and probabilities in other one-way sensitivity analyses.

Our cost-effectiveness analysis suggests that a combination of US and MRI is the most cost-effective strategy in the workup of patients with suspected UNE.