Surgery is more cost-effective than splinting for carpal tunnel syndrome in the Netherlands: results of an economic evaluation alongside a randomized controlled trial

Abstract

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.

Conclusion: In the Netherlands, surgery is more cost-effective compared with splinting, and recommended as the preferred method of treatment for patients with CTS.

Figure 1

Progress of patients through Carpal Tunnel Syndrome (CTS) trial. * Reasons for withdrawal from the study (n = 19): refused to undergo surgery (n = 8); private matters (n = 2); lack of time (n = 1); died of cancer (n = 1); unable to attend the hospital at 12 months (n = 2); did not return the final questionnaire (n = 5). ** Reasons for withdrawal from the study (n = 10): lack of time (n = 3); private matters (n = 1); not satisfied with treatment result (n = 1); unable to attend the hospital at 12 months (n = 1); did not return the final questionnaire (n = 4).

Figure 2

Cost-effectiveness plane comparing surgery and splinting for number of nights awake due to symptoms.

Figure 3

Acceptability curve for surgery vs. splinting for number of nights awake due to symptoms. At a ceiling ratio of EURO 2500 per patient there is a 90% probability that surgery is cost-effective.