• Thompson Zhuang, KortleverJoost T PJTPDepartment of Surgery and Perioperative Care, Dell Medical School-The University of Texas at Austin, Austin, TX., Lauren M Shapiro, Laurence Baker, HarrisAlex H SAHSCenter for Health Care Evaluation, VA Palo Alto Health Care System, Palo Alto, CA., and Robin N Kamal.
• VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, Redwood City, CA.
• J Hand Surg Am. 2020 Oct 1; 45 (10): 899-908.e4.

PurposeTo test the null hypothesis that exposure to societal cost information does not affect choice of treatment for carpal tunnel syndrome (CTS).MethodsWe enrolled 304 participants using the Amazon Mechanical Turk platform to complete a survey in which participants were given the choice between carpal tunnel release (CTR) or a less-expensive option (orthosis wear) in a hypothetical mild CTS scenario. Patients were randomized to receive information about the societal cost of CTR (cost cohort) or no cost information (control). The primary outcome was the probability of choosing CTR measured on a 6-point ordinal scale. We employed qualitative content analysis to evaluate participants' rationale for their choice. We also explored agreement with various attitudes toward health care costs on an ordinal scale.ResultsParticipants in the cost cohort exhibited a greater probability of choosing surgery than those in the control cohort. The relative risk of choosing surgery after exposure to societal cost information was 1.43 (95% confidence interval, 1.11-1.85). Among participants who had not previously been diagnosed with CTS (n = 232), the relative risk of choosing surgery after exposure to societal cost information was 1.55 (95% confidence interval, 1.17-2.06). Lack of personal monetary responsibility frequently emerged as a theme in those in the cost cohort who chose surgery. The majority (94%) of participants expressed at least some agreement that health care cost is a major problem whereas only 58% indicated that they consider the country's health care costs when making treatment decisions.ConclusionsParticipants who received societal cost information were more likely to choose the more expensive treatment option (CTR) for mild CTS.Clinical RelevanceExposure to societal cost information may influence patient decision making in elective hand surgery. A complete understanding of this influence is required prior to implementing processes toward greater cost transparency for diagnostic/treatment options. Sharing out-of-pocket costs with patients may be a beneficial approach because discussing societal cost information alone will likely not improve value of care.Copyright © 2020 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

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