{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T21:02:53Z","timestamp":1791838973728,"version":"4.3.4"},"reference-count":54,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2017,3]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Peripheral nerve transfers to regain elbow flexion via the ulnar nerve (Oberlin nerve transfer) and median nerves are surgical options that benefit patients. Prior studies have assessed the comparative effectiveness of ulnar and median nerve transfers for upper trunk brachial plexus injury, yet no study has examined the cost-effectiveness of this surgery to improve quality-adjusted life years (QALYs). The authors present a cost-effectiveness model of the Oberlin nerve transfer and median nerve transfer to restore elbow flexion in the adult population with upper brachial plexus injury.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n Using a Markov model, the authors simulated ulnar and median nerve transfers and conservative measures in terms of neurological recovery and improvements in quality of life (QOL) for patients with upper brachial plexus injury. Transition probabilities were collected from previous studies that assessed the surgical efficacy of ulnar and median nerve transfers, complication rates associated with comparable surgical interventions, and the natural history of conservative measures. Incremental cost-effectiveness ratios (ICERs), defined as cost in dollars per QALY, were calculated. Incremental cost-effectiveness ratios less than $50,000\/QALY were considered cost-effective. One-way and 2-way sensitivity analyses were used to assess parameter uncertainty. Probabilistic sampling was used to assess ranges of outcomes across 100,000 trials.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n The authors' base-case model demonstrated that ulnar and median nerve transfers, with an estimated cost of $5066.19, improved effectiveness by 0.79 QALY over a lifetime compared with conservative management. Without modeling the indirect cost due to loss of income over lifetime associated with elbow function loss, surgical treatment had an ICER of $6453.41\/QALY gained. Factoring in the loss of income as indirect cost, surgical treatment had an ICER of \u2212$96,755.42\/QALY gained, demonstrating an overall lifetime cost savings due to increased probability of returning to work. One-way sensitivity analysis demonstrated that the model was most sensitive to assumptions about cost of surgery, probability of good surgical outcome, and spontaneous recovery of neurological function with conservative treatment. Two-way sensitivity analysis demonstrated that surgical intervention was cost-effective with an ICER of $18,828.06\/QALY even with the authors' most conservative parameters with surgical costs at $50,000 and probability of success of 50% when considering the potential income recovered through returning to work. Probabilistic sampling demonstrated that surgical intervention was cost-effective in 76% of cases at a willingness-to-pay threshold of $50,000\/QALY gained.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n The authors' model demonstrates that ulnar and median nerve transfers for upper brachial plexus injury improves QALY in a cost-effective manner.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2016.12.focus16469","type":"journal-article","created":{"date-parts":[[2017,3,1]],"date-time":"2017-03-01T03:39:47Z","timestamp":1488339587000},"page":"E11","source":"Crossref","is-referenced-by-count":11,"title":["Analyzing cost-effectiveness of ulnar and median nerve transfers to regain forearm flexion"],"prefix":"10.3171","volume":"42","author":[{"given":"Arvin R.","family":"Wali","sequence":"first","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlie C.","family":"Park","sequence":"additional","affiliation":[{"name":"Radiology, University of California, San Diego, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin M.","family":"Brown","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ross","family":"Mandeville","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-focus16469","series-title":"BioMed Res Int","first-page":"854084","article-title":"Median nerve to biceps nerve transfer to restore elbow flexion in obstetric brachial plexus palsy","volume":"2014","author":"Al-Qattan MM,","year":"2014","unstructured":"Al-Qattan MM, Al-Kharfy TM: Median nerve to biceps nerve transfer to restore elbow flexion in obstetric brachial plexus palsy. BioMed Res Int 2014:854084, 2014"},{"key":"b2-focus16469","series-title":"J Neurosurg Pediatr","first-page":"462","article-title":"Utility of delayed surgical repair of neonatal brachial plexus palsy","volume":"13","author":"Ali ZS,","year":"2014","unstructured":"Ali ZS, Bakar D, Li YR, Judd A, Patel H, Zager EL, : Utility of delayed surgical repair of neonatal brachial plexus palsy. J Neurosurg Pediatr 13:462\u2013470, 2014"},{"key":"b3-focus16469","series-title":"J Neurosurg","first-page":"195","article-title":"Upper brachial plexus injury in adults: comparative effectiveness of different repair techniques","volume":"122","author":"Ali ZS,","year":"2015","unstructured":"Ali ZS, Heuer GG, Faught RW, Kaneriya SH, Sheikh UA, Syed IS, : Upper brachial plexus injury in adults: comparative effectiveness of different repair techniques. J Neurosurg 122:195\u2013201, 2015"},{"key":"b4-focus16469","series-title":"J Bone Joint Surg Am","first-page":"20","article-title":"Complete traumatic brachial plexus palsy. Treatment and outcome after repair","volume":"81","author":"Bentolila V,","year":"1999","unstructured":"Bentolila V, Nizard R, Bizot P, Sedel L: Complete traumatic brachial plexus palsy. Treatment and outcome after repair. J Bone Joint Surg Am 81:20\u201328, 1999"},{"key":"b5-focus16469","series-title":"Med Care","first-page":"349","article-title":"What does the value of modern medicine say about the $50,000 per quality-adjusted life-year decision rule?","volume":"46","author":"Braithwaite RS,","year":"2008","unstructured":"Braithwaite RS, Meltzer DO, King JT Jr, Leslie D, Roberts MS: What does the value of modern medicine say about the $50,000 per quality-adjusted life-year decision rule?. 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Clin Neurol Neurosurg 114:506\u2013514, 2012"},{"key":"b8-focus16469","series-title":"Microsurgery","first-page":"511","article-title":"Median nerve fascicle transfer versus ulnar nerve fascicle transfer to the biceps motor branch in C5\u2013C6 and C5\u2013C7 brachial plexus injuries: nonrandomized prospective study of 23 consecutive patients","volume":"34","author":"Cho AB,","year":"2014","unstructured":"Cho AB, Paulos RG, de Resende MR, Kiyohara LY, Sorrenti L, Wei TH, : Median nerve fascicle transfer versus ulnar nerve fascicle transfer to the biceps motor branch in C5\u2013C6 and C5\u2013C7 brachial plexus injuries: nonrandomized prospective study of 23 consecutive patients. Microsurgery 34:511\u2013515, 2014"},{"key":"b9-focus16469","series-title":"Brain","first-page":"2838","article-title":"Aids to the investigation of peripheral nerve injuries. Medical Research Council Nerve Injuries Research Committee. 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J Neurosurg 98:1005\u20131016, 2003"},{"key":"b16-focus16469","series-title":"J Hand Surg Am","first-page":"978","article-title":"Results of reinnervation of the biceps and brachialis muscles with a double fascicular transfer for elbow flexion","volume":"30","author":"Mackinnon SE,","year":"2005","unstructured":"Mackinnon SE, Novak CB, Myckatyn TM, Tung TH: Results of reinnervation of the biceps and brachialis muscles with a double fascicular transfer for elbow flexion. 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J Hand Surg Am 36:201\u2013208, 2011"},{"key":"b25-focus16469","series-title":"J Hand Surg Am","first-page":"1617","article-title":"Treatment of ulnar neuropathy at the elbow: cost\u2013utility analysis","volume":"37","author":"Song JW,","year":"2012","unstructured":"Song JW, Chung KC, Prosser LA: Treatment of ulnar neuropathy at the elbow: cost\u2013utility analysis. J Hand Surg Am 37:1617\u20131629, 1629.e1\u20131629.e3, 2012"},{"key":"b26-focus16469","series-title":"Microsurgery","first-page":"107","article-title":"Comparison of objective muscle strength in C5\u2013C6 and C5\u2013C7 brachial plexus injury patients after double nerve transfer","volume":"35","author":"Tsai YJ,","year":"2015","unstructured":"Tsai YJ, Su FC, Hsiao CK, Tu YK: Comparison of objective muscle strength in C5\u2013C6 and C5\u2013C7 brachial plexus injury patients after double nerve transfer. Microsurgery 35:107\u2013114, 2015"},{"key":"b27-focus16469","series-title":"J Neurol","first-page":"200","article-title":"Measuring muscle strength","volume":"231","author":"van der Ploeg RJ,","year":"1984","unstructured":"van der Ploeg RJ, Oosterhuis HJ, Reuvekamp J: Measuring muscle strength. J Neurol 231:200\u2013203, 1984"},{"key":"b1-focus16469","series-title":"BioMed Res Int","first-page":"854084","article-title":"Median nerve to biceps nerve transfer to restore elbow flexion in obstetric brachial plexus palsy","volume":"2014","author":"Al-Qattan MM,","year":"2014","unstructured":"Al-Qattan MM, Al-Kharfy TM: Median nerve to biceps nerve transfer to restore elbow flexion in obstetric brachial plexus palsy. 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