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Cost-Effectiveness of Platelet-Rich Plasma Versus Corticosteroid Injections for the Treatment of Mild-to-Moderate Carpal Tunnel Syndrome: A Markov/Monte Carlo Analysis
Kevin M. Klifto, DO, PharmD, University of Missouri, Columbia, MO, Christopher Klifto, MD, Duke Univeristy Hospital, Durham, NC, David S Ruch, MD, Duke University, Durham, NC, Marc Richard, MD, Department of Orthopaedic Surgery, DUKE UNIVERSITY, Durham, NC and Stephen H. Colbert, MD, M349, Division of Plastic, University of Missouri, Columbia, MO

Background: Platelet-rich plasma (PRP) or corticosteroid injections may be used as conservative treatments for mild-to-moderate carpal tunnel syndrome (CTS). We evaluated the cost-effectiveness of PRP injections versus corticosteroid injections for the treatment of mild-to-moderate CTS.
Methods: Markov modeling was used to analyze the base-case 45-year-old patient with mild-to-moderate CTS, unresponsive to conservative treatments (splint, medications, physical therapy), never previously treated with an injection or surgery, treated with a single injection of PRP or methylprednisolone/triamcinolone 40mg/mL. Transition probabilities were derived from 10 Level-I/II studies, quality-of-life (QOL) values from the Tufts University Cost-Effectiveness Analysis Registry reported using visual analog scale (VAS), Boston Carpal Tunnel Questionnaire Symptom severity (BCTQ-S), and Boston Carpal Tunnel Questionnaire Functional status (BCTQ-F), and costs from Medicare reimbursement schedules, published studies, and industry. Analyses were performed from healthcare and societal perspectives. Outcomes were incremental cost-effectiveness ratios (ICER), reported as 2021 United States Dollars/quality-adjusted-life-years (USD/QALY) and net monetary benefits (NMB). Willingness-to-pay thresholds were set at $50,000 and $100,000. Deterministic and probabilistic sensitivity analyses were performed over 10,000 iterations.
Results: From a healthcare perspective, compared to PRP injections, the ICER for methylprednisolone/triamcinolone injections measured by VAS was -$13.52/QALY, BCTQ-S was -$11.88/QALY, and BCTQ-F was -$16.04/QALY. PRP injections provided a NMB measured by VAS of $428,941.12, BCTQ-S of $417,115.09, and BCTQ-F of $421,706.44, compared to a NMB measured by VAS of $375,788.21, BCTQ-S of $356,614.18, and BCTQ-F of $376,908.45. From a societal perspective, compared to PRP injections, the ICER for methylprednisolone/triamcinolone injections measured by VAS was -$1,024.40/QALY, BCTQ-S was -$899.95/QALY, and BCTQ-F was -$1,215.51/QALY. PRP injections provided a NMB measured by VAS of $428,171.63, BCTQ-S of $416,345.61, and BCTQ-F of $420,936.95, compared to a NMB measured by VAS of $373,944.39, BCTQ-S of $354,770.36, and BCTQ-F of $375,064.63.
Conclusions: PRP injections were more cost-effective than methylprednisolone/triamcinolone injections from healthcare and societal perspectives for the treatment of mild-to-moderate CTS.
Level of Evidence: Economic Level-II


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