Cost-Effectiveness of Open Versus Endoscopic Carpal Tunnel Release
| العنوان: | Cost-Effectiveness of Open Versus Endoscopic Carpal Tunnel Release |
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| المؤلفون: | Steven M. Asch, Laurence C. Baker, Robin N. Kamal, Gabrielle M. Paci, James Barnes, Thompson Zhuang |
| المصدر: | J Bone Joint Surg Am |
| بيانات النشر: | Ovid Technologies (Wolters Kluwer Health), 2020. |
| سنة النشر: | 2020 |
| مصطلحات موضوعية: | medicine.medical_specialty, Cost effectiveness, Cost-Benefit Analysis, Medicare, Article, 03 medical and health sciences, 0302 clinical medicine, Humans, Medicine, Orthopedics and Sports Medicine, Local anesthesia, 030212 general & internal medicine, Carpal tunnel syndrome, Sensitivity analyses, health care economics and organizations, 030222 orthopedics, business.industry, Endoscopy, General Medicine, Evidence-based medicine, Decompression, Surgical, medicine.disease, Carpal Tunnel Syndrome, Markov Chains, United States, Additional research, Endoscopic carpal tunnel release, Physical therapy, Surgery, Quality-Adjusted Life Years, business, Decision analysis |
| الوصف: | Background Carpal tunnel syndrome is the most common upper-extremity nerve compression syndrome. Over 500,000 carpal tunnel release (CTR) procedures are performed in the U.S. yearly. We estimated the cost-effectiveness of endoscopic CTR (ECTR) versus open CTR (OCTR) using data from published meta-analyses comparing outcomes for ECTR and OCTR. Methods We developed a Markov model to examine the cost-effectiveness of OCTR versus ECTR for patients undergoing unilateral CTR in an office setting under local anesthesia and in an operating-room (OR) setting under monitored anesthesia care. The main outcomes were costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). We modeled societal (modeled with a 50-year-old patient) and Medicare payer (modeled with a 65-year-old patient) perspectives, adopting a lifetime time horizon. We performed deterministic and probabilistic sensitivity analyses (PSAs). Results ECTR resulted in 0.00141 additional QALY compared with OCTR. From a societal perspective, assuming 8.21 fewer days of work missed after ECTR than after OCTR, ECTR cost less across all procedure settings. The results are sensitive to the number of days of work missed following surgery. From a payer perspective, ECTR in the OR (ECTROR) cost $1,872 more than OCTR in the office (OCTRoffice), for an ICER of approximately $1,332,000/QALY. The ECTROR cost $654 more than the OCTROR, for an ICER of $464,000/QALY. The ECTRoffice cost $107 more than the OCTRoffice, for an ICER of $76,000/QALY. From a payer perspective, for a willingness-to-pay threshold of $100,000/QALY, OCTRoffice was preferred over ECTROR in 77% of the PSA iterations. From a societal perspective, ECTROR was preferred over OCTRoffice in 61% of the PSA iterations. Conclusions From a societal perspective, ECTR is associated with lower costs as a result of an earlier return to work and leads to higher QALYs. Additional research on return to work is needed to confirm these findings on the basis of contemporary return-to-work practices. From a payer perspective, ECTR is more expensive and is cost-effective only if performed in an office setting under local anesthesia. Level of evidence Economic and Decision Analysis Level I. See Instructions for Authors for a complete description of levels of evidence. |
| تدمد: | 1535-1386 0021-9355 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::6abab7fed2925928770c84d99d2d5f70 https://doi.org/10.2106/jbjs.19.01354 |
| حقوق: | OPEN |
| رقم الأكسشن: | edsair.doi.dedup.....6abab7fed2925928770c84d99d2d5f70 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 15351386 00219355 |
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