Surgery is more cost-effective than splinting for carpal tunnel syndrome in the Netherlands: results of an economic evaluation alongside a randomized controlled trial.
BACKGROUND
Carpal tunnel syndrome (CTS) is a common disorder, often treated with surgery or wrist splinting. The objective of this economic evaluation alongside a randomized trial was to evaluate the cost-effectiveness of splinting and surgery for patients with CTS.


METHODS
Patients at 13 neurological outpatient clinics with clinically and electrophysiologically confirmed idiopathic CTS were randomly allocated to splinting (n = 89) or surgery (n = 87). Clinical outcome measures included number of nights waking up due to symptoms, general improvement, severity of the main complaint, paraesthesia at night and during the day, and utility. The economic evaluation was performed from a societal perspective and involved all relevant costs.


RESULTS
There were no differences in costs. The mean total costs per patient were in the surgery group EURO 2,126 compared to EURO 2,111 in the splint group. After 12 months, the success rate in the surgery group (92%) was significantly higher than in the splint group (72%). The acceptability curve showed that at a relatively low ceiling ratio of EURO 2,500 per patient there is a 90% probability that surgery is cost-effective.


CONCLUSIONS
In the Netherlands, surgery is more cost-effective compared with splinting, and recommended as the preferred method of treatment for patients with CTS.
Korthals-de Bos
Ingeborg B C
IB
Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam, the Netherlands. i.korthals@voorankerhuizen.nl <i.korthals@voorankerhuizen.nl>
Gerritsen
Annette A M
AA
van Tulder
Maurits W
MW
Rutten-van Mölken
Maureen P M H
MP
Adèr
Herman J
HJ
de Vet
Henrica C W
HC
Bouter
Lex M
LM
D002349:Carpal Tunnel Syndrome / Q000601:surgery / Q000628:therapy*; D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D006295:Health Resources / Q000706:statistics & numerical data; D006801:Humans; D009426:Netherlands; D019637:Orthopedic Procedures / Q000191:economics*; D013165:Splints / Q000191:economics*; D016896:Treatment Outcome