Simple decompression or anterior subcutaneous transposition for ulnar neuropathy at the elbow: a cost-minimization analysis--Part 2.
OBJECTIVE
A randomized controlled trial was reported recently, in which simple decompression and anterior subcutaneous transposition were compared for treatment of ulnaropathy at the elbow. Clinically, both surgical options seem to be equally effective. The objective of this study is to compare the costs, from a societal standpoint, of simple decompression versus anterior subcutaneous transposition in Euros.


METHODS
Published and unpublished data from a randomized controlled trial that compared simple decompression and anterior subcutaneous transposition were used. The investigators tabulated the actual costs incurred for professional fees, use of the operating room, duration of sick leave, reintervention, and treatment of complications directly related to the surgical treatment.


RESULTS
The total costs per group and per patient were statistically significantly less for those treated with simple decompression. The total median costs per patient were 1124 Euros for simple decompression and 2730 Euros for anterior subcutaneous transposition. The main difference was in the costs related to sick leave, which is significantly shorter for simple decompression. There also was a statistically significant difference in operation time in favor of simple decompression. A remarkable finding was that paid workers in both treatment groups returned to work much later than unpaid workers.


CONCLUSIONS
Although clinically equally effective, simple decompression was associated with lower cost than anterior subcutaneous transposition for the treatment of ulnar neuropathy at the elbow. Compared with anterior subcutaneous transposition, we recommend simple decompression for the treatment of idiopathic ulnar neuropathy at the elbow.
Bartels
Ronald H M A
RH
Department of Neurosurgery, University Medical Center St. Radboud, Nijmegen, The Netherlands. r.bartels@nch.umcn.nl
Termeer
Evelien H
EH
van der Wilt
Gert Jan
GJ
van Rossum
Leo G M
LG
Meulstee
Jan
J
Verhagen
Wim I M
WI
Grotenhuis
J André
JA
D000041:Absenteeism; D000328:Adult; D000368:Aged; D003363:Cost Control; D019299:Decompression, Surgical / Q000191:economics*; D004550:Elbow; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D019635:Neurosurgical Procedures / Q000191:economics; D011446:Prospective Studies; D016037:Single-Blind Method; D016896:Treatment Outcome; D014459:Ulnar Nerve / Q000601:surgery*; D017769:Ulnar Nerve Compression Syndromes / Q000191:economics / Q000601:surgery*