Vasen A P, Kuntz K M, Simmons B P, Katz J N
Seaview Orthopaedic and Medical Associates, Neptune, NJ, USA.
J Hand Surg Am. 1999 Sep;24(5):1109-17. doi: 10.1053/jhsu.1999.1109.
The endoscopic technique for the surgical treatment of carpal tunnel syndrome was developed to decrease postoperative morbidity and accelerate a patient's return to normal activities and work. We used the methods of decision analysis to compare the total cost of the open versus the endoscopic technique. We adopted a societal perspective and included estimates of the costs of medical procedures and complications, as well as lost wages. Our base case analysis showed that the 2 techniques have similar total costs, given the assumptions of our model. The endoscopic approach is more costly if the complication rate of endoscopic surgery exceeds 6.2% (base case estimate, 5.0%). The endoscopic technique is more costly if the risk of career ending injury exceeds 0.001 (base case estimate, 0.0004) and if the average work absence following a complication exceeds 15.5 months (base case estimate, 12 months). In addition, the endoscopic technique is more costly if the difference between the 2 techniques in mean time to return to work is less than 21 days (base case estimate, 26 days). These findings have different implications for recipients and non-recipients of workers' compensation. If endoscopically treated patients return to work an average of 42 days faster than patients treated with the open technique (24 days vs 66 days), as was documented for non-recipients of workers' compensation in one large study, the endoscopic strategy would be less costly ($5,599 for endoscopic release vs $7,340 for open surgery). If endoscopically treated patients return to work an average of just 10 days sooner (103 days vs 113 days), however, as was documented for workers' compensation recipients in the same study, the open technique would be less costly ($11,353 for open release vs $11,959 for the endoscopic technique). The relative costs are not sensitive to the direct medical costs of complications. These findings allow prediction of the costs of endoscopic and open surgery under a range of assumptions concerning key parameters. The analyses also emphasize the need for more precise data on risks and costs of surgical treatments for carpal tunnel syndrome.
用于腕管综合征手术治疗的内镜技术旨在降低术后发病率，并加速患者恢复正常活动和工作。我们采用决策分析方法比较开放手术与内镜技术的总成本。我们采用社会视角，纳入了医疗程序和并发症的成本估计以及工资损失。我们的基础病例分析表明，在我们模型的假设下，这两种技术的总成本相似。如果内镜手术的并发症发生率超过6.2%（基础病例估计为5.0%），内镜手术方法成本更高。如果职业终结性损伤风险超过0.001（基础病例估计为0.0004），并且并发症后的平均缺勤时间超过15.5个月（基础病例估计为12个月），内镜技术成本更高。此外，如果两种技术在平均恢复工作时间上的差异小于21天（基础病例估计为26天），内镜技术成本更高。这些发现对工伤赔偿的接受者和非接受者有不同的影响。如果接受内镜治疗的患者比接受开放技术治疗的患者平均早42天恢复工作（24天对66天），正如一项大型研究中记录的非工伤赔偿接受者那样，内镜策略成本更低（内镜松解术为5599美元，开放手术为7340美元）。然而，如果接受内镜治疗的患者仅平均早10天恢复工作（103天对113天），正如同一研究中记录的工伤赔偿接受者那样，开放技术成本更低（开放松解术为11353美元，内镜技术为11959美元）。相对成本对并发症的直接医疗成本不敏感。这些发现使得在一系列关于关键参数的假设下能够预测内镜手术和开放手术的成本。这些分析还强调了需要关于腕管综合征手术治疗风险和成本的更精确数据。
