An Economic Analysis of the Timing of Microsurgical Reconstruction in Brachial Plexus Birth Palsy
Bibliographic record
Abstract
BACKGROUND: The role and timing of microsurgical reconstruction of the brachial plexus in infants who have no signs of biceps recovery within the first six months of life is controversial. The purpose of the present study was to create an economic model to compare microsurgical treatment at three as opposed to six months in patients with brachial plexus birth palsy who had no return of biceps function at three months. METHODS: A cost-minimization study was performed with use of a decision-analysis model. Natural history, success, and tendon transfer and osteotomy rates were estimated from the literature. Costs were estimated from a single center. RESULTS: The literature on patients without nerve root avulsion supports an 80% rate of biceps recovery between three and six months of age. On the basis of this value, microsurgical intervention at three months was more expensive than microsurgical intervention at six months. Microsurgical intervention at three months cost more than twice as much as intervention at six months. Sensitivity analysis revealed that when the rate of biceps recovery was 40% and surgery at three months was three times more successful than surgery at six months, then both treatments had equal costs. CONCLUSIONS: It is unlikely that microsurgical intervention at three months for the treatment of rupture injuries of the brachial plexus will be successful enough to produce overall cost savings. While our results should not be used to dictate policy decisions as they are not definitive and remain contingent on future studies, it is still reasonable to consider economic factors and quality-of-life outcomes in brachial plexus birth palsy treatment strategies and future research.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.022 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.003 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".