Ultrasound as a First-line Test in the Diagnosis of Carpal Tunnel Syndrome: A Cost-effectiveness Analysis
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Clin Orthop Relat Res (2013) 471:932–937 DOI 10.1007/s11999-012-2662-3
A Publication of The Association of Bone and Joint Surgeons®
CLINICAL RESEARCH
Ultrasound as a First-line Test in the Diagnosis of Carpal Tunnel Syndrome: A Cost-effectiveness Analysis John R. Fowler MD, Mitchell G. Maltenfort PhD, Asif M. Ilyas MD
Received: 31 March 2012 / Accepted: 12 October 2012 / Published online: 6 November 2012 Ó The Association of Bone and Joint Surgeons1 2012
Abstract Background The American Academy of Orthopaedic Surgeons (AAOS) recommends that surgeons obtain a confirmatory test in patients for whom carpal tunnel surgery is being considered. The AAOS, however, does not specify a preferred test. Ultrasound reportedly causes less patient discomfort and takes less time to perform, while maintaining comparable sensitivity and specificity to electrodiagnostic testing (EDX). Questions/purposes We determined whether ultrasound as a first-line diagnostic test is more cost-effective than using EDX alone or using ultrasound alone: (1) when used by a general practitioner; and (2) when used by a specialist. Methods A fictional population of patients was created and each patient was randomly assigned a probability of having true-positive, false-positive, true-negative, and truepositive ultrasound and EDX tests over an expected range of sensitivity and specificity values using Monte Carlo Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request. This work was performed at Temple University Hospital, Philadelphia, PA, USA. J. R. Fowler (&) Department of Orthopaedics, University of Pittsburgh Medical Center, Kaufmann Medical Building, Suite 1010, 3471 Fifth Avenue, Pittsburgh, PA 15123, USA e-mail: [email protected] M. G. Maltenfort, A. M. Ilyas Rothman Institute, Philadelphia, PA, USA
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methods. Charges were assigned based on Medicare charges for diagnostic tests and estimates of missed time from work. Results The average charge for the use of ultrasound as a first-line diagnostic test followed by EDX for confirmation of a negative ultrasound test was $562.90 per patient in the general practitioner scenario and $369.50 per patient in the specialist scenario, compared with $400.30 and $428.30 for EDX alone, respectively. Conclusions The use of diagnostic ultrasound as a firstline test for confirmation of a clinical diagnosis of carpal tunnel syndrome is a more cost-effective strategy in the specialist population and results in improved false-negative rates in the generalist population despite increased cost. Level of Evidence Level III, economic and decision analyses. See the Guidelines for Authors for a co
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