Title : Cost-effectiveness of endoscopic versus open carpal tunnel release: A scoping review
Abstract:
Background: Endoscopic Carpal Tunnel Release (ECTR) is increasing in popularity globally and has been associated with faster functional recovery and earlier return to work compared with Open Carpal Tunnel Release (OCTR). Despite these advantages, its cost-effectiveness remains uncertain, particularly within publicly funded healthcare systems.
Methods: A PRISMA-ScR-compliant scoping review was undertaken. Peer-reviewed studies were identified through PubMed, Scopus, ProQuest, OpenAlex, and citation tracking. Studies reporting cost analyses or cost-minimisation strategies in ECTR, with or without comparison with OCTR, were included. Extracted data included study design, geographic origin, cost perspective, and key economic findings. Data were synthesised using descriptive and thematic analysis.
Results: Fifty-one studies met inclusion criteria, predominantly comprising retrospective cohort and observational designs, with marked heterogeneity in costing methods and outcome measures. A consistent finding was that ECTR incurs higher direct procedural costs, largely related to specialised equipment and staffing requirements. However, many studies demonstrated that these increased upfront costs may be offset by indirect economic benefits, particularly earlier return to work and shorter recovery periods. Interpretation was limited by retrospective methodologies, variation in study time horizons, and over-reliance on surrogate economic measures. Modifiable cost drivers were identified in both ECTR and OCTR, including anaesthetic technique and operative setting. Emerging evidence also suggests that patients with bilateral carpal tunnel syndrome may be suitable candidates for simultaneous bilateral release, offering potential reductions in cumulative healthcare utilisation and recovery-related costs.
Conclusion/Findings: The current evidence base is fragmented and methodologically heterogeneous, limiting its applicability to clinical decision-making. While ECTR demonstrates potential for indirect economic benefit, its overall value remains context dependent.
Implications: Future research should prioritise prospective, standardised economic evaluations incorporating societal perspectives, with specific relevance to national health systems such as the NHS. Cost analyses among patients suitable for simultaneous bilateral ECTR were not identified in this review.
