A Prospective, Randomized Study with an Independent Observer Comparing Open Carpal Tunnel Release with Endoscopic Carpal Tunnel Release

Jacobsen, M. B.; Rahme, Hans

doi:10.1016/s0266-7681(96)80097-0

Cited by 86 publications

(82 citation statements)

References 10 publications

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“…It is well known that 'return to work' is inversely related to the painful scar at the base of the palm (6,36,37). In our decision analytical model, this complication had a probability of 6.8% for OCTR and the probability of scar tenderness was 1.4% (6,(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)33). By not including this common complication in previous studies, with the endoscopic technique, one can bias the costs and utilities in favour of the endoscopic release.…”

Section: Discussionmentioning

confidence: 88%

“…The probabilities for the health states for this analysis were obtained from 16 randomized, controlled trials comparing ECTR with OCTR (6,(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)33). When these 16 randomized controlled trials were combined, the total number of ECTRs performed was 739 and the total number OCTRs performed was 859 (6,(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)33).…”

Section: Health Statesmentioning

confidence: 99%

“…When these 16 randomized controlled trials were combined, the total number of ECTRs performed was 739 and the total number OCTRs performed was 859 (6,(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)33). The probabilities of each outcome state are shown in Figure 1.…”

Section: Health Statesmentioning

confidence: 99%

“…With regard to return to work, there remains some controversy. Some studies have found that ECTR patients return to work earlier (6,(8)(9)(10)(11)(12)(13)(14)(15) and some other studies have determined that there is no difference in time off work (16)(17)(18)(19)(20)(21). Part of the controversy may be how return to work was measured in the different studies (22).…”

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confidence: 99%

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

Thoma¹,

Wong²

2006

CAN J PLAST SURG

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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.

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Section: Discussionmentioning

confidence: 88%

Section: Health Statesmentioning

confidence: 99%

Section: Health Statesmentioning

confidence: 99%

mentioning

confidence: 99%

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

Thoma¹,

Wong²

2006

CAN J PLAST SURG

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“…The success of carpal tunnel release is high, with 84% patient satisfaction (7). Given that scar tenderness is one of the main drawbacks (8), various techniques have been introduced to minimize this complication (7,9,10).…”

mentioning

confidence: 99%

A Methodological Guide to Performing a Cost-Utility Study Comparing Surgical Techniques

Thoma

Haines

Veltri

et al. 2004

Canadian Journal of Plastic Surgery

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A Thoma, T Haines, K Veltri, CH Goldsmith, BJ O'Brien, C Quartly. A methodological guide to performing a cost-utility study comparing surgical techniques. Can J Plast Surg 2004;12(4):179-187.BACKGROUND: When recommending the adoption of a new surgical intervention as opposed to maintaining an old one, surgeons need to consider the opportunity cost, which is the value of the forgone benefits. To inform these decisions, surgeons can use economic analyses of surgical practices. Unfortunately, economic analyses conducted alongside randomized controlled trials in surgery are rare. OBJECTIVES: The objective of the present study was to use data from a small randomized controlled trial to illustrate the methodology for a cost-utility analysis comparing two techniques of carpal tunnel release: open release without ('usual' technique) and with ('novel' technique) ligament reconstruction. METHODS: Eighteen eligible patients were entered into this prospective study. Fifteen were followed to six weeks postoperatively. One day preoperatively, and five days, three weeks and six weeks postoperatively, patients completed a self-administered Health Utilities Index Mark 2-3 questionnaire (utilities) and a case report form from which resource utilization (cost) was collected. Utilities were expressed as quality-adjusted life weeks, a fraction of qualityadjusted life years. RESULTS: The mean total cost of the usual technique was lower than the novel technique, and the mean quality-adjusted life week was higher, favouring the usual technique. Indirect costs were four to nine times higher than direct costs in both techniques. CONCLUSION: The novel technique was more costly and less effective, and fell in the 'lose-lose' quadrant of the cost-effectiveness plane; it was rejected in favour of the usual technique. This methodology should be applied when deciding whether to adopt novel surgical techniques in plastic surgery to optimize scarce health care resources.

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Clinical management of carpal tunnel syndrome: A 12-year review of outcomes

et al. 1999

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Carpal tunnel syndrome (CTS) is a disorder frequently encountered by occupational health care specialists. The health care management of this disorder has involved a diverse set of clinical procedures. The present article is a review of the literature related to CTS with an emphasis on occupational‐related CTS. MEDLINE, Cumulative Index to Nursing and Allied Health Literature, PsycLIT, and NIOSHTIC databases from 1985–1997 were searched for treatment outcome studies related to CTS. Treatments of interest included surgery, physical therapy, drug therapy, chiropractic treatment, biobehavioral interventions, and occupational rehabilitation. A systematic review of the effects of these interventions on symptoms, medical status, function, return to work, psychological well‐being, and patient satisfaction was completed. Compared to other treatments, the majority of studies assessed the effects of surgical interventions. Endoscopic release was associated with higher levels of physical functioning and fewer days to return to work when compared to open release. Limited evidence indicated: 1) steroid injections and oral use of B6 were associated with pain reduction; 2) in comparison to splinting, range of motion exercises appeared to be associated with less pain and fewer days to return to work; 3) cognitive behavior therapy yielded reductions in pain, anxiety, and depression; and, 4) multidisciplinary occupational rehabilitation was associated with a higher percentage of chronic cases returning to work than usual care. Workers' compensation status was associated with increased time to return to work following surgery. Conclusions are preliminary due to the small number of well‐controlled studies, variability in duration of symptoms and disability, and the broad range of reported outcome measures. While there are several opinions regarding effective treatment, there is very little scientific support for the range of options currently used in practice. Despite the emerging evidence of the multivariate nature of CTS, the majority of outcome studies have focused on single interventions directed at individual etiological factors or symptoms and functional limitations secondary to CTS. Am. J. Ind. Med. 35:232–245, 1999. © 1999 Wiley‐Liss, Inc.

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A Prospective, Randomized Study with an Independent Observer Comparing Open Carpal Tunnel Release with Endoscopic Carpal Tunnel Release

Cited by 86 publications

References 10 publications

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

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

A Methodological Guide to Performing a Cost-Utility Study Comparing Surgical Techniques

Clinical management of carpal tunnel syndrome: A 12-year review of outcomes

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