两种手术环境下内窥镜腕管松解术的“患者特异性”成本和质量价值比较

Q3 Medicine

Journal of Hand Surgery Global Online Pub Date : 2025-08-13 DOI:10.1016/j.jhsg.2025.100802

Alex Lindahl BS , Trae Hill BS , Emily Mazier BS , Meet Patel BS , Geoffrey Kahn PhD , Yueren Zhou PhD , Charles S. Day MD, MBA

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引用次数: 0

摘要

先前的研究表明，将手术从医院门诊部（HOPD）转移到门诊外科中心（ASC）可以降低成本。每年有50万例腕管松解术（carpal tunnel release， CTR）， CTR为确定上肢手术的价值提供了一个机会。我们的目标是通过分析成本和患者结果的差异，量化内镜CTR在HOPD中与ASC相比的价值。我们假设ASC将通过降低成本同时保持患者预后来提供更大的价值。方法总成本由时间驱动的基于作业的人工成本（TDABC）、基于作业的供应成本和基于索赔的设施成本组成。计算术前患者报告结局测量（PROM）信息系统上肢（UE）和疼痛干扰（PI）评分与术后3个月PROM信息系统UE和PI评分的差异，以确定PROM信息系统质量调整生命年（QALYUE/PI）。总成本除以每个PROM的qaly来计算每个队列的value /PI。通过计算增量成本-效果比来阐明队列之间价值差异的大小。结果每组共25例患者。与HOPD相比，ASC的成本降低了28%（3,370.73±128.80美元vs 4,654.75±140.19美元）。与HOPD相比，ASC患者的平均QALYUE和QALYPI增益并没有显著增加(QALYUE 1.06 vs 0.89；QALYPI 1.22 vs 0.92)。与HOPD相比，ASC显示出40%至45%的价值，其成本/QALY较低（ValueUE $3,168.81/QALY vs $5,242.78/QALY, ValuePI $2,759.90/QALY vs $5,038.04/QALY）。结论：我们观察到在ASC中进行ct治疗的价值提高了40%至45%。虽然ASCs降低了28%的成本，但成本本身并不能完全解释价值差异。患者报告的结果在提供提供给患者的价值的整体图景方面发挥了重要作用。医生可以利用这些信息指导患者选择腕管综合征的手术治疗方案。研究类型/证据水平经济/决策分析

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

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.