We used decision-analysis modeling to determine the most cost-effective fixation device among Herbert screws, AO screws, and the Luhr plate for first metatarsophalangeal joint arthrodesis. The model considered patient-reported outcomes at minimum 2-year follow-up, patient charges for the entire course of care, and event and outcome incidences within each fixation group. AO screws had the lowest average cost of utility and, therefore, are the most cost-effective fixation device for first metatarsophalangeal joint arthrodesis even though utility is highest with the Luhr plate. Operating room costs and union rate most strongly influenced cost-effectiveness.
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