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Cost-Minimization Analysis of Open and Endoscopic Carpal Tunnel Release

Zhang, Steven BA; Vora, Molly; Harris, Alex H.S. PhD; Baker, Laurence PhD; Curtin, Catherine MD; Kamal, Robin N. MD

Journal of Bone & Joint Surgery - American Volume: 7 December 2016 - Volume 98 - Issue 23 - p 1970–1977
doi: 10.2106/JBJS.16.00121
Scientific Articles

Background: Carpal tunnel release is the most common upper-limb surgical procedure performed annually in the U.S. There are 2 surgical methods of carpal tunnel release: open or endoscopic. Currently, there is no clear clinical or economic evidence supporting the use of one procedure over the other. We completed a cost-minimization analysis of open and endoscopic carpal tunnel release, testing the null hypothesis that there is no difference between the procedures in terms of cost.

Methods: We conducted a retrospective review using a private-payer and Medicare Advantage database composed of 16 million patient records from 2007 to 2014. The cohort consisted of records with an ICD-9 (International Classification of Diseases, Ninth Revision) diagnosis of carpal tunnel syndrome and a CPT (Current Procedural Terminology) code for carpal tunnel release. Payer fees were used to define cost. We also assessed other associated costs of care, including those of electrodiagnostic studies and occupational therapy. Bivariate comparisons were performed using the chi-square test and the Student t test.

Results: Data showed that 86% of the patients underwent open carpal tunnel release. Reimbursement fees for endoscopic release were significantly higher than for open release. Facility fees were responsible for most of the difference between the procedures in reimbursement: facility fees averaged $1,884 for endoscopic release compared with $1,080 for open release (p < 0.0001). Endoscopic release also demonstrated significantly higher physician fees than open release (an average of $555 compared with $428; p < 0.0001). Occupational therapy fees associated with endoscopic release were less than those associated with open release (an average of $237 per session compared with $272; p = 0.07). The total average annual reimbursement per patient for endoscopic release (facility, surgeon, and occupational therapy fees) was significantly higher than for open release ($2,602 compared with $1,751; p < 0.0001).

Conclusions: Our data showed that the total average fees per patient for endoscopic release were significantly higher than those for open release, although there currently is no strong evidence supporting better clinical outcomes of either technique.

Clinical Relevance: Value-based health-care models that favor delivering high-quality care and improving patient health, while also minimizing costs, may favor open carpal tunnel release.

1Stanford University School of Medicine, Stanford, California

2Boston University, Boston, Massachusetts

3Center for Health Care Evaluation, VA Palo Alto Health Care System, Menlo Park, California

4Department of Health Research and Policy, Stanford University, Stanford, California

5Department of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, California

6Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California

E-mail address for S. Zhang: sezhang@stanford.edu

E-mail address for M. Vora: mollyv@bu.edu

E-mail address for A.H.S. Harris: alexander.harris2@med.va.gov

E-mail address for L. Baker: laurence.baker@stanford.edu

E-mail address for C. Curtin: ccurtin@stanford.edu

E-mail address for R. Kamal: rnkamal@stanford.edu

Copyright 2016 by The Journal of Bone and Joint Surgery, Incorporated
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