Analysis of Expected Costs of Carpal Tunnel Syndrome Treatment Strategies.
Analysis of Expected Costs of Carpal Tunnel Syndrome Treatment Strategies.
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DOI：
10.1177/1558944717743597
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发表时间：
2019-05-01
期刊：
影响因子：
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通讯作者：
Capo, John T
中科院分区：
文献类型：
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作者：
Milone, Michael T;Karim, Adnan;Capo, John T
背景：在美国，每年有超过50万例腕管松解手术，花费超过20亿美元。该研究的目的是进行成本最小化分析，以确定最低成本的策略，利用现有的成功率为基础的腕管综合征治疗先前报道的literature.METHODS：我们评估的预期成本的各种治疗策略的基础上进一步治疗的可能性：（1）一个单一的类固醇注射，然后手术释放;（2）多达2类固醇注射手术释放前;（3）术前3次类固醇注射，和（4）立即手术释放。为了反映成本，我们使用我们机构对私人付款人的收费和医疗保险的报销。一系列的预期类固醇注射成功率采用基于以前发表的literature.RESULTS：立即手术释放是最昂贵的治疗，预计成本为2149美元至9927美元每例患者。为了使立即手术释放的成本低于单次注射尝试，注射后手术的概率在医疗保险报销模式中需要超过80%，在机构计费模式中需要超过87%。如果需要的话，一次类固醇注射和随后的手术，与立即手术释放相比，每年可节省3.59亿美元的直接成本。手术前三次注射，与“高”预期成功率，代表成本最小化scenarios.CONCLUSIONS：虽然许多因素必须考虑在决定治疗腕管综合征时，直接付款成本是一个重要组成部分，并与类固醇注射的初始管理最大限度地减少这些直接付款成本。
BACKGROUND: Over 500 000 carpal tunnel releases costing over $2 billion are performed each year in the United States. The study's purpose is to perform a cost-minimizing analysis to identify the least costly strategy for carpal tunnel syndrome treatment utilizing existing success rates based on previously reported literature.METHODS: We evaluate the expected cost of various treatment strategies based on the likelihood of further treatments: (1) a single steroid injection followed by surgical release; (2) up to 2 steroid injections before surgical release; (3) 3 steroid injections before surgery, and (4) immediate surgical release. To reflect costs, we use our institution's billing charges to private payers and reimbursements from Medicare. A range of expected steroid injection success rates are employed based on previously published literature.RESULTS: Immediate surgical release is the costliest treatment with an expected cost of $2149 to $9927 per patient. For immediate surgical release to cost less than a single injection attempt, the probability of surgery after injection would need to exceed 80% in the Medicare reimbursement model and 87% in the institutional billing model. A single steroid injection with subsequent surgery, if needed, amounts to a direct cost savings of $359 million annually compared with immediate surgical release. Three injections before surgery, with "high" expected success rates, represent the cost-minimizing scenario.CONCLUSIONS: Although many factors must be considered when deciding upon treatment for carpal tunnel syndrome, direct payer cost is an important component, and the initial management with steroid injections minimizes these direct payer costs.