Endoscopic versus open carpal tunnel release: A randomized trial

MacDermid, Joy C.; Richards, Rickelle; Roth, James H.; Ross, Doug C.; King, Graham J.W.

doi:10.1053/jhsu.2003.50080

Cited by 174 publications

(115 citation statements)

References 22 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: 90%

“…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).…”

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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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: 90%

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 double minimal incision technique has the various advantages of an endoscopic procedure but also has some disadvantages. The double-incision technique is relatively easy to perform and allows rapid postoperative recovery 14 . This technique did not result in a higher risk of postoperative complications, expense, or increase in surgical time compared to the single-incision technique 9,15 .…”

Section: Discussionmentioning

confidence: 99%