A cost-utility analysis of open and endoscopic carpal tunnel release

Abstract

BACKGROUND: Open carpal tunnel release (OCTR) is the standard procedure for the surgical treatment of carpal tunnel syndrome. With the advent of minimally invasive surgery, endoscopic carpal tunnel release (ECTR) was introduced. OBJECTIVE: To use a decision analytical model to compare ECTR with OCTR in an economic evaluation. METHODS: Direct medical costs were obtained from a Canadian university hospital. Utility values obtained from experts, presented with carpal tunnel syndrome outcome health states, were transformed into quality-adjusted life years (QALYs). The probabilities of the health states associated with both techniques were obtained from the literature. RESULTS: The incremental cost-utility ratio (ICUR) was $124,311.32/QALY gained, providing strong evidence to reject ECTR when ECTR is performed in the main operating room and OCTR is performed in the day surgery unit. A one-way sensitivity analysis in the present study demonstrated that when both OCTR and ECTR are performed in day surgery unit, the ICUR falls in the 'win-win' quadrant, making ECTR both more effective and less costly than OCTR. If the scar tenderness probability is decreased in the ECTR group in a second one-way sensitivity analysis, the ICUR decreases to $100,621.91/QALY gained, providing evidence to reject ECTR. If the reflex sympathetic dystrophy probability is increased in the ECTR group in a third one-way sensitivity analysis, the ICUR increases to $202,657.88/QALY gained, providing strong evidence to reject ECTR. CONCLUSIONS: There is still uncertainty associated with the costs and effectiveness of ECTR and OCTR. To obtain a definitive answer as to whether the ECTR is more effective than the OCTR, it is necessary to perform a large, randomized, controlled trial in which the utilities and resource use are measured prospectively.

Is there Light at the End of the Tunnel? Controversies in the Diagnosis and Management of Carpal Tunnel Syndrome

“…They concluded that minimally invasive surgery was more effective and more costly, but that the increased expense was not justified. In a similar study Thoma et al [57] concluded that uncertainty still existed with regards to cost and effectiveness of endoscopic procedures. Their study was influenced specifically by whether the procedure was performed in day surgery or main theatres; if an endoscopic procedure was performed within a day theatre, the incremental cost utility ratio became favourable.…”

Endoscopic versus open carpal tunnel release for idiopathic carpal tunnel syndrome: a meta-analysis of randomized controlled trials

“…The published meta-analysis by Thoma et al [38], Vasiliadis et al [39], and Chen et al [40] reported a larger sample size and more randomized controlled trials than the current study, but they investigated CTS patients without exclusion of patients with rheumatoid arthritis (RA) and other inflammatory arthropathies, trauma, diabetes, acromegaly, hypothyroidism, and pregnancy; thus, the current study specifically provided a more accurate evidence for idiopathic CTS concerning surgical option with OCTR and ECTR.…”

The performance and publication of cost-utility analyses in plastic surgery: Making our specialty relevant

“…Some recent economic evaluations in the field of plastic surgery can be found in Table 4 (31). The authors found that endoscopic carpal tunnel release costs an additional $124,311/QALY over open carpal tunnel release.…”

“…The authors found that endoscopic carpal tunnel release costs an additional $124,311/QALY over open carpal tunnel release. This value exceeds the acceptable threshold; therefore, it is not recommended that this technique be adopted (31). In 2004, an analysis by Rockwell and Thoma (32) examined prophylactic plating of a donor radius following the harvest of a radial osteocutaneous flap.…”