Costo-utilidad de intervenciones en pacientes con síndrome del túnel carpiano atendidos en un centro de alta complejidad en Cali, Colombia

Abstract

Introduction: Although there are several treatments for carpal tunnel syndrome (CTS), the efficiency of these has not evaluated in Colombia. Objective: Determine the incremental cost-utility ratio (ICUR) of medical and surgical treatment in patients with CTS. Material and methods: A cost utility analysis was conducted from the societal perspective with patients older than 18 years diagnosed with CTS who received medical or surgical treatment. Quality-adjusted life-years (QALYs) were calculated using the EQ-5D. Costs were obtained from the ISS national tariff 2001+30 %. The results were extrapolated to long term through a Markov model with a discount rate of 3,5 %. A probabilistic sensitivity analysis using Monte Carlo simulation was performed. Results: Fifty- three patients participated, women (71,7 %); mean age: 55,5 years. 79 % of patients received medical treatment. The most frequent treatment was medical observation (66,7 %) and NSAIDs (16,6 %). Medical treatment provided 0,33 QALYs (± 0,11) and surgery 0,37 (± 0,10). The average total cost of medical treatment at 6 months and 20 years was COP 132 006 (95 % CI: COP 70 255 - 425 341) and COP 483 440 (95 % CI: COP 104 310 - 862 570) respectively. The cost of surgery was COP 1 972 644 (95 % CI: COP 981 204 - 8 517 065) and COP 979 585 (95 %: COP 684 912 - 1 274 258). The surgery was dominated by 6 months. The ICUR at 20 years was COP 1 033 635/QALY additional (95 % CI: COP 840 179 - 1 235 323/additional QALY) with a 80 % of probability that surgery be cost-utility when there is a willingness to pay COP 5 000 000. Conclusion: The medical treatment is cost-effective with regard to the surgery in short term. However, in the long term the surgery is cost effective with respect to the medical treatment.