title: Carpal tunnel syndrome, the search for a cost-effective surgical intervention: a randomised controlled trial.
abstract: OBJECTIVE
  There is insufficient evidence regarding the clinical and cost-effectiveness of surgical interventions for carpal tunnel syndrome. This study evaluates the cost, effectiveness and cost-effectiveness of minimally invasive surgery compared with conventional open surgery.
  
  
  METHODS
  194 sufferers (208 hands) of carpal tunnel syndrome were randomly assigned to each treatment option. A self-administered questionnaire assessed the severity of patients' symptoms and functional status pre- and postoperatively. Treatment costs were estimated from resource use and hospital financial data.
  
  
  RESULTS
  Minimally invasive carpal tunnel decompression is marginally more effective than open surgery in terms of functional status, but not significantly so. Little improvement in symptom severity was recorded for either intervention. Minimally invasive surgery was found to be significantly more costly than open surgery. The incremental cost effectiveness ratio for functional status was estimated to be 197 UK pounds, such that a one percentage point improvement in functioning costs 197 UK pounds when using the minimally invasive technique.
  
  
  CONCLUSIONS
  Minimally invasive carpal tunnel decompression appears to be more effective but more costly. Initial analysis suggests that the additional expense for such a small improvement in function and no improvement in symptoms would not be regarded as value-for-money, such that minimally invasive carpal tunnel release is unlikely to be considered a cost-effective alternative to the traditional open surgery procedure.
authors.affiliation: Health Economics Group, School of Medicine, Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ, UK. p.lorgelly@uea.ac.uk
authors.forename: Paula K
authors.initials: PK
authors.lastname: Lorgelly
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Dias
authors.forename: Mary J
authors.initials: MJ
authors.lastname: Bradley
authors.forename: Frank D
authors.initials: FD
authors.lastname: Burke
mesh_terms: D002349:Carpal Tunnel Syndrome / Q000191:economics / Q000601:surgery*; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D019299:Decompression, Surgical / Q000191:economics / Q000379:methods*; D004739:England; D017721:Hospital Costs; D006801:Humans; D019060:Minimally Invasive Surgical Procedures / Q000191:economics / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome