Simultaneous Bilateral Versus Staged Bilateral Carpal Tunnel Release: A Cost-effectiveness Analysis

Area of Science:

• Orthopedic Surgery
• Health Economics
• Decision Analysis

Background:

• Bilateral carpal tunnel syndrome (CTS) affects both wrists, impacting quality of life.
• Treatment options include staged or simultaneous bilateral carpal tunnel release (CTR).
• Cost-effectiveness of simultaneous versus staged bilateral CTR requires evaluation.

Purpose of the Study:

• To compare the cost-effectiveness of simultaneous bilateral CTR versus staged bilateral CTR for treating bilateral CTS.
• To evaluate three strategies: bilateral simultaneous CTR, bilateral staged CTR, and no treatment.

Main Methods:

• A decision analytic model was employed to compare cost-effectiveness.
• Direct medical costs were based on 2013 Medicare rates and drug costs.
• Indirect costs utilized institutional data and national wage data; health utilities were derived from SF-6D questionnaires.

Main Results:

• Both surgical strategies were found to be cost-effective compared to no treatment.
• Simultaneous bilateral CTR demonstrated lower total costs and higher total effectiveness than staged bilateral CTR.
• The incremental cost-effectiveness ratio for simultaneous bilateral CTR was $921 per quality-adjusted life year.

Conclusions:

• Surgical management is a cost-effective treatment for bilateral carpal tunnel syndrome.
• Simultaneous bilateral CTR is superior to staged bilateral CTR, offering lower costs and greater effectiveness.