Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


The Cost-Effectiveness of Corticosteroid Injection of the Carpal Tunnel.

DeLea1,  Suzanne L., Poole1,  Janet L., Chavez-Chiang2,  Natalia, Sibbitt3,  Wilmer L., Bankhurst4,  Arthur D.

University of New Mexico, Albuquerque, NM
University of New Mexico
University of New Mexico HSC, Albuquerque, NM
University of NM Med Ctr, Albuquerque, NM

Objective:

Corticosteroid injection is a useful and low-cost therapy for carpal tunnel syndrome.This randomized controlled study addressed whether two different low-cost injection techniques affected the outcomes and cost-effectiveness of carpal tunnel injections.

Design:

Prospective, randomized, controlled, single-blinded interventional trial.

Setting:

Hospital outpatient musculoskeletal clinic.

Patients:

64 subjects with symptomatic carpal tunnel syndrome.

Interventions:

64 wrists with carpal tunnel syndrome were randomized to palpation-guided anatomic carpal tunnel injection with 80 mg triamcinolone acetonide by: 1) a conventional technique, or 2) injection by a mechanical syringe, the RPD (the reciprocating procedure device) syringe. A one-needle, two-syringe technique with hydrodissection by 1% lidocaine was used.

Main Outcome Measurements:

Baseline pain by 10 cm Visual Analogue Pain Scale (10 cm VAS), procedural pain, pain at outcome (2 weeks and 6 months), responders, therapeutic duration, reinjection rates, total cost/patient/year, and cost/responder/year were determined.

Results:

Both methods reduced pains cores by greater than 50% from baseline at 2 weeks (p<0.001). Relative to the conventional method, the mechanical syringe resulted in 62% greater reduction in injection pain (p<0.02), a 68% increase in responder rate (p<0.02), 50% reduction in non-responder rate (p<0.02), 57% increase in therapeutic duration (p <0.001), a 25% increase in time to next procedure, a 36% ($43 US) reduction in cost/patient/yr for a patient treated in a physician office (p<0.001), and a 34% reduction ($33 US) in cost/patient/year for a hospital outpatient (p<0.001) as well as reduced cost/responder/year (p<0.001).

Figure 1.

Figure 2.

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Figure 4.

Conclusion:

Cost-effectiveness and outcomes of corticosteroid injection for carpal tunnel syndrome can be significantly improved by using low-cost alterations in technique.

To cite this abstract, please use the following information:
DeLea, Suzanne L., Poole, Janet L., Chavez-Chiang, Natalia, Sibbitt, Wilmer L., Bankhurst, Arthur D.; The Cost-Effectiveness of Corticosteroid Injection of the Carpal Tunnel. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1567
DOI: 10.1002/art.29333

Abstract Supplement

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