{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T21:02:54Z","timestamp":1791838974119,"version":"4.3.4"},"reference-count":64,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,7]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Pan\u2013brachial plexus injury (PBPI), involving C5\u2013T1, disproportionately affects young males, causing lifelong disability and decreased quality of life. The restoration of elbow flexion remains a surgical priority for these patients. Within the first 6 months of injury, transfer of spinal accessory nerve (SAN) fascicles via a sural nerve graft or intercostal nerve (ICN) fascicles to the musculocutaneous nerve can restore elbow flexion. Beyond 1 year, free-functioning muscle transplantation (FFMT) of the gracilis muscle can be used to restore elbow flexion. The authors present the first cost-effectiveness model to directly compare the different treatment strategies available to a patient with PBPI. This model assesses the quality of life impact, surgical costs, and possible income recovered through restoration of elbow flexion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A Markov model was constructed to simulate a 25-year-old man with PBPI without signs of recovery 4.5 months after injury. The management options available to the patient were SAN transfer, ICN transfer, delayed FFMT, or no treatment. Probabilities of surgical success rates, quality of life measurements, and disability were derived from the published literature. Cost-effectiveness was defined using incremental cost-effectiveness ratios (ICERs) defined by the ratio between costs of a treatment strategy and quality-adjusted life years (QALYs) gained. A strategy was considered cost-effective if it yielded an ICER less than a willingness-to-pay of $50,000\/QALY gained. Probabilistic sensitivity analysis (PSA) was performed to address parameter uncertainty.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>The base case model demonstrated a lifetime QALYs of 22.45 in the SAN group, 22.0 in the ICN group, 22.3 in the FFMT group, and 21.3 in the no-treatment group. The lifetime costs of income lost through disability and interventional\/rehabilitation costs were $683,400 in the SAN group, $727,400 in the ICN group, $704,900 in the FFMT group, and $783,700 in the no-treatment group. Each of the interventional modalities was able to dramatically improve quality of life and decrease lifelong costs. A Monte Carlo PSA demonstrated that at a willingness-to-pay of $50,000\/QALY gained, SAN transfer dominated in 88.5% of iterations, FFMT dominated in 7.5% of iterations, ICN dominated in 3.5% of iterations, and no treatment dominated in 0.5% of iterations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>This model demonstrates that nerve transfer surgery and muscle transplantation are cost-effective strategies in the management of PBPI. These reconstructive neurosurgical modalities can improve quality of life and lifelong earnings through decreasing disability.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2017.4.focus17112","type":"journal-article","created":{"date-parts":[[2017,7,1]],"date-time":"2017-07-01T03:36:24Z","timestamp":1498880184000},"page":"E4","source":"Crossref","is-referenced-by-count":12,"title":["Nerve transfer versus muscle transfer to restore elbow flexion after pan\u2013brachial plexus injury: a cost-effectiveness analysis"],"prefix":"10.3171","volume":"43","author":[{"given":"Arvin R.","family":"Wali","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David R.","family":"Santiago-Dieppa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin M.","family":"Brown","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ross","family":"Mandeville","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","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"},{"issue":"5","key":"b2","series-title":"Neurosurg Focus","first-page":"E8","article-title":"Gracilis free muscle transfer for restoration of function after complete brachial plexus avulsion","volume":"16","author":"Barrie KA","year":"2004","unstructured":"Barrie KA, Steinmann SP, Shin AY, Spinner RJ, Bishop AT: Gracilis free muscle transfer for restoration of function after complete brachial plexus avulsion. Neurosurg Focus 16(5):E8, 2004"},{"key":"b3","series-title":"J Neurosurg","first-page":"365","article-title":"Surgical repair of brachial plexus injury: a multinational survey of experienced peripheral nerve surgeons","volume":"101","author":"Belzberg AJ","year":"2004","unstructured":"Belzberg AJ, Dorsi MJ, Storm PB, Moriarity JL: Surgical repair of brachial plexus injury: a multinational survey of experienced peripheral nerve surgeons. J Neurosurg 101:365\u2013376, 2004"},{"key":"b4","series-title":"Hand Clin","first-page":"91","article-title":"Functioning free-muscle transfer for brachial plexus injury","volume":"21","author":"Bishop AT","year":"2005","unstructured":"Bishop AT: Functioning free-muscle transfer for brachial plexus injury. Hand Clin 21:91\u2013102, 2005"},{"key":"b5","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? Med Care 46:349\u2013356, 2008"},{"key":"b6","series-title":"Microsurgery","first-page":"511","article-title":"Median nerve fascicle transfer versus ulnar nerve fascicle transfer to the biceps motor branch in C5-C6 and C5-C7 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-C6 and C5-C7 brachial plexus injuries: nonrandomized prospective study of 23 consecutive patients. Microsurgery 34:511\u2013515, 2014"},{"key":"b7","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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