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Surgery vs NA
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01/29/07 21:23
jim_h 
01/29/07 21:23
jim_h 
Re: Surgery vs NA

Regarding the cost of NA compared to surgery... both of my surgeries involved several locations. The second surgery was on 2 fingers so the cost for NA would have been at least $1400. Add round-trip air fare to Florida, and a night or two in a hotel... and if I had to repeat NA in a couple of years, the cost is getting out of range for me unless my insurance plan picks up 100% of Dr. Eaton's charges. If not, I'm saving my insurance company a lot of money by selecting this procedure, but the cost to me personally willl be a lot higher.

I don't have an expert frame of reference on whether $700 per finger is a reasonable charge. I do know that the European MDs charge a fraction of this amount. Certainly there are many costs involved in offering this procedure here in the US, but that doesn't explain why a second finger done at the same time also costs $700.

I think one reason Dr. Eaton may be having some success in presenting this procedure to American hand surgeons is that he shows them that offering the NA procedure is not, at roughly $1400 per hour, going to reduce their incomes.




01/30/07 02:12
Randy_H 

Moderator

01/30/07 02:12
Randy_H 

Moderator

Re: Surgery vs NA

Jim, I think $1,400 per hour is inflated. Eaton spent at least 45 minutes with me personally for one finger. He spends a lot of time working the palm as well + injections. Personally I don't object to CHS making the same $/hour as they do with OS. As you say, NA is not going to cause them to lose revenue. Should It?

01/30/07 05:19
jim_h 
01/30/07 05:19
jim_h 
Re: Surgery vs NA

A doctor in private practice has the right to charge whatever he sees fit. There's nothing wrong with becoming expert at something that few people can do, finding a big demand for it and making a lot of money - as long as the market is free and open to the entry of competition.

Insurance companies already pay less for an NA procedure than for a conventional surgery; so at this point they may not be concerned with reducing the cost further.



01/30/07 06:39
DianeS 
01/30/07 06:39
DianeS 
Re: Surgery vs NA

When comparing cost, don't forget the charges of the hospital or outpatient surgery center and anesthesiologist. It adds up. And while for some people, open surgery is a long term fix, for some of us there is still rapid recurrence and we need surgery every couple of years. NA was a lot cheaper for me even though the OS surgeon was contracted under my insurance carrier but my subswquent NA surgeon (Dr. Denkler) is not.

Also consider lost earnings from greater recovery time. I was retired at the time of my second OS but know I would have lost productivity even though I had a desk job.

01/30/07 07:39
Randy_H 

Moderator

01/30/07 07:39
Randy_H 

Moderator

Re: Surgery vs NA

Dianes,

Not to mention the higher rate of complications for Invasive Surgery, the data of which was presented to the ASSH. This should come as no surprise. The correlation between invasiveness and complications are well known in al types of surgery, especially orthopedic. The only question is: can the less invasive do the trick? Quite often you don't know until you try. This then is the main argument for trying NA as the first line procedure in most cases.

01/30/07 17:35
jim_h 
01/30/07 17:35
jim_h 
Re: Surgery vs NA

All true. I also have a big stack of bills for months of physical therapy. The 'hassle factor' of surgery - months of disablity, lost opportunities, lack of exercise, time spent on exercises and wound dressing - can't be measured, but it's enormous.

My point was just that when NA first came onto our radar, it was so cheap that it was a no-brainer, assuming you'd enjoy a trip to Paris for it's own sake. When it came to the U.S., the cost took a really big jump and I'm not sure why.

I'd like to be certain that my insurance plan would cover it even if I need repeated treatments over the years. I'd like more MDs offer it, at lower cost and closer to where I live. Alternatively, I'd like to see Dr. Eaton move to someplace more interesting than Jupiter, Florida :-)

03/06/07 12:45
Wolfgang

not registered

03/06/07 12:45
Wolfgang

not registered

Re: Surgery vs NA

Interesting paper:

AL van Rijssen, FS Gerbrandy, H ter Linden, H Klip, abd PM Werker

"A comparison of the direct outcomes of percutaneous needle fasciotomy and limited fasciectomy for Dupuytren's disease: a 6-week follow-up study"

J Hand Surg [Am] 31 (2006) p 717-25

Their conclusions (NA is here called PNF=percutanous needle fasciotomy while LF stands for Limited Fasciectomy, the usual Dupuytren surgery):
"Tubiana stages I and II showed no difference between these treatments, but for rays higher than stage II LF clearly was superior to PNF as a treatment modality. The rate of major complications in the LF group was 5% versus 0% in the PNF group. Patient satisfaction was almost equal but direct hand function after treatment was considered better in the PNF group, as was the degree of discomfort that patients experienced. This was underscored by the Disabilities of the Arm, Shoulder, and Hand scores in the PNF group, which were significantly lower than those in the LF group at all time points measured. CONCLUSIONS: In the short term and in cases with a TPED of 90 degrees or less PNF is a good treatment alternative to LF for treatment of Dupuytren's disease."

03/07/07 23:45
bstenman 
03/07/07 23:45
bstenman 
Re: Surgery vs NA

Wolfgand -
Thanks for the summation. It mirrors my own conclusions that the side effects, in particular the loss of hand strength, and the long recovery period even with physical therapy of a fasciectomy.

I have been trying to get information on radiation treatment as a follow-up treatment after NA has been performed as a way to reduce the likelihood of further disease progression. I have been unable to find anyone who speaks English at the two clinics in Montreal, or to get questions answered in emails to Professor Seegenschmiedt by way of Christiane Kerstan.

I am scheduled for NA with Dr. Denkler (CHS) in Larkspur, California next week. Blue Cross covers the cost of the consultation and the procedure.

http://www.plasticsurgerysf.com/dupuytrens/

Bruce

03/08/07 05:45
Mark_D 
03/08/07 05:45
Mark_D 
Re: Surgery vs NA

Bruce:

You probably already know this, but Dr. Denkler is a superstar -- and a great guy.

Good luck!

Mark

03/08/07 07:17
Wolfgang

not registered

03/08/07 07:17
Wolfgang

not registered

Radiotherapy after NA

Hi Bruce, my 5 cents but really my personal opinion: radiation therapy is known to be efficient it the infant stage of Dupuytren where it can stop the initial, small nodules from further growth. When cords are already big, and if you are getting NA yours probably are, then radiation therapy can at best slow down growth of the cords. That might help to reduce/postpone recurrence and that's why radiotherapy is being considered as post-treatment after NA. But there isn't any experience available yet because this therapy has been used so far primarily for the initial stage. In short: it might be interesting to try but don't expect too much. Maybe the magic works, maybe it doesn't.

I have been talking to Christiane Kerstan just yesterday and will be in Essen in two weeks. Can I do anything for you?

Give my regard to Keith Denkler. He is a great guy.

Wolfgang

Quote:


I have been trying to get information on radiation treatment as a follow-up treatment after NA has been performed as a way to reduce the likelihood of further disease progression. I have been unable to find anyone who speaks English at the two clinics in Montreal, or to get questions answered in emails to Professor Seegenschmiedt by way of Christiane Kerstan.

I am scheduled for NA with Dr. Denkler (CHS) in Larkspur, California next week.


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