Cost-Effectiveness of Open Versus Endoscopic Carpal Tunnel Release

Abstract

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.

Endoscopic Carpal Tunnel Release: Techniques, Controversies, and Comparison to Open Techniques

“…The exact difference in procedural time is likely irrelevant and would not affect cost-effectiveness studies in a significant manner. 34…”

“…With the assumption that patients undergoing ECTR were able to return to work 8.21 days earlier than those undergoing OCTR, they found that ECTR was actually more cost-effective than OCTR from the societal perspective. 34 ECTR was also more cost-effective from the payor perspective when using a willingness-to-pay threshold of $100,000/quality-adjusted life year, a common threshold used in healthcare cost-effectiveness studies. 34,35 Specifically, ECTR in the office setting is the most cost-effective measure, followed by ECTR in the operating room, OCTR in the office setting, and OCTR in the operating room.…”

“…34 ECTR was also more cost-effective from the payor perspective when using a willingness-to-pay threshold of $100,000/quality-adjusted life year, a common threshold used in healthcare cost-effectiveness studies. 34,35 Specifically, ECTR in the office setting is the most cost-effective measure, followed by ECTR in the operating room, OCTR in the office setting, and OCTR in the operating room. Cost-effectiveness studies have many inherent limitations including numerous variables and assumptions gathered from other studies, but are still frequently used to justify reimbursement of procedures.…”

Initial Outcomes of a Novel Modification of Looped Threaded Carpal Tunnel Release Method

“…7,8 In addition to the open procedure, minimally invasive methods with small incisions and endoscopic surgery have been developed to lessen these sequels, specifically pillar pain and scar discomfort. [8][9][10] Recently the ultrasound-guided looped thread carpal tunnel release (TCTR) technique has been introduced that provides the nerve decompensation by running the thread under and over the TCL followed by oscillating the thread in the distal direction and severing the TCL indirectly. 11,12 This study was designed and performed to present a novel approach to cutting TCL by the thread looping technique without the use of ultrasonography.…”

Procedural Technique for Wide Awake Local Anesthesia No Tourniquet Injection for Endoscopic Carpal Tunnel Release

“…1 Carpal tunnel release is one of the most common procedures of the upper extremity in the United States, with greater than 500,000 cases completed annually. 2 It is either performed as either an open CTR (OCTR) or endoscopic CTR (ECTR) procedure. However, there is no consensus on superiority of the 2 approaches.…”