Open versus endoscopic carpal tunnel release: A decision analysis

Vasen, Arthur P.; Kuntz, Karen M.; Simmons, Barry P.; Katz, Jeffrey N.

doi:10.1053/jhsu.1999.1109

Cited by 51 publications

(36 citation statements)

References 17 publications

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“…Surprisingly, although the literature suggests a relationship between the tender scar after OCTR and absence from work, Vasen et al (24) did not include it in their decision analytical model. It is well known that 'return to work' is inversely related to the painful scar at the base of the palm (6,36,37).…”

Section: Discussionmentioning

confidence: 99%

“…The outcome used in the study was QALYs. Others have used 'days until return to work' for the costeffectiveness analysis (24,25). Vasen et al (24) reported that if the gain in 'return to work' with the endoscopic technique (22).…”

Section: Discussionmentioning

confidence: 99%

“…The probabilities of each outcome state are shown in Figure 1. The pathways and probabilities comparing the two techniques were modified from a decision analytical model (24). The main modifications were the exclusion of the median nerve transection and the addition of scar tenderness as an important health state.…”

Section: Health Statesmentioning

confidence: 99%

“…Although there is general agreement that the scar from the ECTR technique is less painful, the potential transection of the median nerve with its ramifications makes ECTR a controversial technique (24). The inadvertent transection of the median nerve featured prominently in previous cost-effectiveness analysis (25) and decision analysis (24) articles.…”

mentioning

confidence: 99%

“…The inadvertent transection of the median nerve featured prominently in previous cost-effectiveness analysis (25) and decision analysis (24) articles. Recent clinical research (23), however, identified that irreversible nerve damage is rare and can occur in either the OCTR or the ECTR technique.…”

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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