Research Mentor Name

Dr. Charles S. Day

Research Mentor Email Address

Institution / Department

Henry Ford Health System

Document Type

Research Abstract

Research Type


Level of Research



Beyond Traditional Metrics: Assessing Value in Carpal Tunnel Surgeries

Meet Patel1, Emily Mazier2, Megan Carulla1, Trae Hill1, Alex Lindahl2, Charles S. Day3

1Wayne State University, Detroit, MI, 2Oakland University William Beaumont, Auburn Hills, MI, 3Henry Ford Medical System, Detroit, MI


To control healthcare costs, one must consider cost-effectiveness and quality of care metrics. This study compares the value of carpal tunnel release (CTR) performed in the ambulatory surgical center (ASC) to the hospital outpatient department (HOPD).


Costs were determined by the Time-Driven Activity-Based Costing (TDABC) methodology. All steps of a patient care pathway for CTR performed in ASC and HOPD were organized into a process map. Costs were categorized into the following:

  • Direct Variable: Staff salaries directly involved in patient care
  • Direct Fixed: Materials, supplies, and building fees
  • Indirect: Maintenance, administration, and marketing

Differences in pre-operative and 3-month post-operative PROMIS UE and PI scores were multiplied by average life-years remaining for each patient to determine quality-adjusted life-years (QALY). Costs were divided by QALYUE and QALYPI to determine incremental cost-effectiveness ratios (ICER), denoted as ICERUE and ICERPI.


16 HOPD patients were compared to 18 ASC patients. Costs were significantly lower in the ASC by $951.15, or 30.5% (p<0.001). HOPD QALYUE was greater than ASC QALYUE (0.858 vs 0.702) (p=0.899). HOPD QALYPI was greater than ASC QALYPI (1.274 vs 0.988) (p=0.796). ICERUE was greater in the HOPD by $6097/QALY. ICERPI was greater in the HOPD by $3325.69/QALY.


Higher ICER values indicate the HOPD provides less value, despite having better outcomes compared to the ASC. The significant decrease in cost shows the ASC to be more cost-effective.

Significance/Clinical relevance: As healthcare costs continue to rise, value-based care will maintain a pivotal role. Combining TDABC and PROs to determine value can aid clinicians in decision-making.


Medicine and Health Sciences