University of Missouri School of Medicine, Columbia, USA.
Duke University School of Medicine, Durham, NC, USA.
Hand (N Y). 2024 Jan;19(1):113-127. doi: 10.1177/15589447221092056. Epub 2022 May 22.
Platelet-rich plasma (PRP) or corticosteroid injections may be used to conservatively treat mild-to-moderate carpal tunnel syndrome (CTS). We evaluated the cost-effectiveness of PRP injections versus corticosteroid injections for the treatment of mild-to-moderate CTS.
Markov modeling was used to analyze the base-case 45-year-old patient with mild-to-moderate CTS, unresponsive to conservative treatments, never previously treated with an injection or surgery, treated with a single injection of PRP, or methylprednisolone/triamcinolone 40 mg/mL. Transition probabilities were derived from level-I/II studies, utility values from the Tufts University Cost-Effectiveness Analysis Registry reported using visual analog scale (VAS), Boston Carpal Tunnel Questionnaire Symptom severity (BCTQ-S), and Boston Carpal Tunnel Questionnaire Functional status (BCTQ-F), and costs from Medicare, published studies, and industry. Analyses were performed from healthcare/societal perspectives. Outcomes were incremental cost-effectiveness ratios (ICER) and net monetary benefits (NMB). Willingness-to-pay thresholds were $50 000 and $100 000. Deterministic/probabilistic sensitivity analyses were performed.
From a healthcare perspective, compared to PRP injections, the ICER for corticosteroid injections measured by VAS: -$13.52/quality-adjusted-life-years (QALY), BCTQ-S: -$11.88/QALY, and BCTQ-F: -$16.04/QALY. PRP versus corticosteroid injections provided a NMB measured by VAS: $428 941.12 versus $375 788.21, BCTQ-S: $417 115.09 versus $356 614.18, and BCTQ-F: $421 706.44 versus $376 908.45. From a societal perspective, compared to PRP injections, the ICER for corticosteroid injections measured by VAS: -$1024.40/QALY, BCTQ-S: -$899.95/QALY, and BCTQ-F: -$1215.51/QALY. PRP versus corticosteroid injections provided a NMB measured by VAS: $428 171.63 versus $373 944.39, BCTQ-S: $416 345.61 versus $354 770.36, and BCTQ-F: $420 936.95 versus $375 064.63.
PRP injections were more cost-effective than methylprednisolone/triamcinolone injections from healthcare and societal perspectives for mild-to-moderate CTS.
富血小板血浆 (PRP) 或皮质类固醇注射可用于保守治疗轻中度腕管综合征 (CTS)。我们评估了 PRP 注射与皮质类固醇注射治疗轻中度 CTS 的成本效益。
使用马尔可夫模型分析了基线时 45 岁的轻中度 CTS 患者，对保守治疗无反应，从未接受过注射或手术治疗，接受单次 PRP 或甲泼尼龙/曲安奈德 40mg/ml 注射治疗。转移概率来自一级/二级研究，效用值来自 Tufts 大学成本效益分析登记处，使用视觉模拟量表 (VAS)、波士顿腕管综合征问卷症状严重程度 (BCTQ-S) 和波士顿腕管综合征问卷功能状态 (BCTQ-F) 报告，成本来自医疗保险、已发表的研究和行业。分析采用医疗保健/社会视角。结果为增量成本效益比 (ICER) 和净货币收益 (NMB)。支付意愿阈值为 50,000 美元和 100,000 美元。进行了确定性/概率敏感性分析。
从医疗保健的角度来看，与 PRP 注射相比，皮质类固醇注射的 VAS 测量的 ICER：-13.52 美元/质量调整生命年 (QALY)，BCTQ-S：-11.88 美元/QALY，BCTQ-F：-16.04 美元/QALY。PRP 与皮质类固醇注射相比，VAS 测量的 NMB：428,941.12 美元比 375,788.21 美元，BCTQ-S：417,115.09 美元比 356,614.18 美元，BCTQ-F：421,706.44 美元比 376,908.45 美元。从社会角度来看，与 PRP 注射相比，皮质类固醇注射的 VAS 测量的 ICER：-1024.40 美元/QALY，BCTQ-S：-899.95 美元/QALY，BCTQ-F：-1215.51 美元/QALY。PRP 与皮质类固醇注射相比，VAS 测量的 NMB：428,171.63 美元比 373,944.39 美元，BCTQ-S：416,345.61 美元比 354,770.36 美元，BCTQ-F：420,936.95 美元比 375,064.63 美元。
从医疗保健和社会角度来看，PRP 注射治疗轻中度 CTS 的成本效益优于甲泼尼龙/曲安奈德注射。
