“Patient-Specific” Cost and Quality Value Comparison of Endoscopic Carpal Tunnel Release in Two Surgical Settings

Abstract

Purpose

Prior studies have demonstrated that transitioning surgeries from a hospital outpatient department (HOPD) to an ambulatory surgical center (ASC) lowers costs. With 500,000 carpal tunnel release (CTR) surgeries annually, CTR offers an opportunity to determine the value of one of the most performed upper-extremity surgeries. We aim to quantify the value of an endoscopic CTR in a HOPD compared to an ASC by analyzing differences in costs and patient outcomes. We hypothesize the ASC will provide greater value by lowering costs while maintaining patient outcomes.

Methods

Total costs were comprised of time-driven activity-based labor costs (TDABC), activity-based supply costs, and claims-based facility costs. Differences in preoperative Patient-Reported Outcome Measure (PROM) Information System Upper Extremity (UE) and Pain Interference (PI) scores and 3-month postoperative PROM Information System UE and PI scores were calculated to determine PROM Information System Quality-Adjusted Life Years (QALY_UE/PI). Total costs were divided by QALYs for each PROM to calculate the Value_UE/PI of each cohort. The magnitude of the difference in value between cohorts was elucidated by calculating incremental cost-effectiveness ratios.

Results

A total of 25 patients comprised each cohort. The ASC generated 28% lower costs compared to the HOPD ($3,370.73 ± $128.80 vs $4,654.75 ± $140.19). Average QALY_UE and QALY_PI gain was not significantly greater for patients at the ASC compared to the HOPD (QALY_UE 1.06 vs 0.89; QALY_PI 1.22 vs 0.92). The ASC demonstrated 40% to 45% greater value, represented by a lower cost/QALYs, compared to the HOPD (Value_UE $3,168.81/QALY vs $5,242.78/QALY, Value_PI $2,759.90/QALY vs $5,038.04/QALY).

Conclusions

We observed between 40% to 45% greater value by performing CTRs in the ASC. Although ASCs lowered costs by 28%, costs alone do not fully explain the value differential. Patient-reported outcomes serve a valuable role in providing a holistic picture of the value being delivered to patients. Providers can use this information to guide patient decision-making regarding operative treatment options for carpal tunnel syndrome.

Type of study/level of evidence

Economic/Decision Analysis II.