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      Cost of surgical treatment for ulnar nerve entrapment in Finland, 2011–2015: a registry-based cost description study

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          Abstract

          Objectives

          The aim of this study was to evaluate the cost of surgical treatment for primary ulnar nerve entrapment (UNE) borne by the public sector in Finland.

          Design

          Registry-based cost description study.

          Setting

          Primary and secondary care throughout Finland.

          Participants

          We identified all the patients diagnosed with primary UNE in the whole population of Finland from 2011 to 2015 from the Care Register for Health Care. From these patients, we identified those who had undergone ulnar nerve release during the year they were diagnosed or the following year.

          Interventions

          Open ulnar nerve release.

          Outcome measures

          The primary outcome measure was cost borne by the public sector in 2015 euros. The cost of surgery was based on the diagnosis-related group prices. We calculated the cost of a single visit to a primary care physician, an electroneuromyography examination, a preoperative visit to a hand surgeon and a follow-up appointment by telephone in specialised care for each patient. These unit costs were provided by the Finnish Institute for Health and Welfare and the same costs were used for each patient. We obtained the number of reimbursed sick days and the total amount reimbursed to each patient in euros within the 2 years after diagnosis from the Social Insurance Institution of Finland.

          Results

          During our study period, approximately 1786 primary UNE diagnoses were made yearly, and on average, 876 (49%) of patients received surgical treatment annually. The surgery-related cost per patient averaged at EUR 1341 (43%) and reimbursed sick leaves at EUR 952 (30%) during this period. The annual cost of surgical treatment for UNE borne by the public sector in Finland varied between EUR 3082 and EUR 3213 per patient.

          Conclusions

          The average cost of surgical treatment for UNE in Finland was EUR 3140 per patient between 2011 and 2015.

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          Most cited references14

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          Quality of the Finnish Hospital Discharge Register: a systematic review.

          Reijo Sund (2012)
          The Finnish Hospital Discharge Register (FHDR) is one of the oldest individual level hospital discharge registers and has been intensively used for research purposes. The aim of this study was to gather information concerning the quality of FHDR into one place in terms of a systematic review of validation studies that compare data to external information. Several reference databases were searched for validity articles published until January 2012. For each included study, focus of validation, register years examined, number of compared observations, external source(s) of data, summary of validation results, and conclusions concerning the validity of FHDR were extracted. In total, 32 different studies comparing FHDR data to external information were identified. Most of the studies examined validity in the case of vascular disease, mental disorders or injuries. More than 95% of discharges could be identified from the register. Positive predictive value (PPV) for common diagnoses was between 75 and 99%. Completeness and accuracy in the register seem to vary from satisfactory to very good in the register as long as the recognised limitations are taking into account. Poor recording of subsidiary diagnoses and secondary operations and other rarely used items are the most obvious limitations in validity, but do not compromise the value of data in FHDR in being used in studies that are not feasible to conduct otherwise.
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            Incidence of common compressive neuropathies in primary care.

            Apart from carpal tunnel syndrome, there are no population based studies of the epidemiology of compressive neuropathies. To provide this information, new presentations of compressive neuropathies among patients registered with 253 general practices in the UK General Practice Research Database with 1.83 million patient years at risk in 2000 were analysed. The study revealed that in 2000 the annual age standardised rates per 100 000 of new presentations in primary care were: carpal tunnel syndrome, men 87.8/women 192.8; Morton's metatarsalgia, men 50.2/women 87.5; ulnar neuropathy, men 25.2/women 18.9; meralgia paraesthetica, men 10.7/women 13.2; and radial neuropathy, men 2.97/women 1.42. New presentations were most frequent at ages 55-64 years except for carpal tunnel syndrome, which was most frequent in women aged 45-54 years, and radial nerve palsy, which was most frequent in men aged 75-84 years. In 2000, operative treatment was undertaken for 31% of new presentations of carpal tunnel syndrome, 3% of Morton's metatarsalgia, and 30% of ulnar neuropathy.
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              Incidence of ulnar neuropathy at the elbow in the province of Siena (Italy).

              Although ulnar neuropathy at the elbow (UNE) is the second most frequent focal peripheral neuropathy of the upper limb after carpal tunnel syndrome (CTS), no figures on its prevalence or incidence in the general population have been reported. To determine the incidence of UNE in a general population. Retrospective study to identify newly diagnosed cases on the basis of clinical symptoms or signs and slowing of motor conduction velocity of the ulnar nerve across the elbow or surgical evidence of nerve compression in the elbow region. In the 5-year period from 1995 to 1999, cases among residents in Siena Province (Italy) were identified from medical records of electromyographic services of Local Health District no. 7 and from hospital medical records coded ICD 354.2, 04.49 and 04.6. Siena province has a population of 251,930. In the 5-year period, 311 cases (112 women and 199 men, mean age 56 years, range 15-86) were identified. The mean annual crude incidence was 24.7 cases per 100,000 person-years, and the standardized incidence was 20.9. The sex-specific incidences were 32.7 for men and 17.2 for women. The mean annual crude and sex-specific incidences remained constant during the study period. The age-specific incidences of whole population and both genders showed an increasing trend with decade of age. The incidence of "possible", "probable" and "definite" UNE cases, classified according to level of motor conduction velocity anomalies and evidence of surgical compression of the ulnar nerve at the elbow, was 4.3, 10.6, and 9.8, respectively. The residents of a health subdistrict where manual work is dominant had a higher male-specific incidence (57.1) than other areas. This is the first published study on the incidence of UNE. The incidence was higher in males than females and about one-thirteenth that reported for CTS in part of the present geographic area.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2023
                1 June 2023
                : 13
                : 6
                : e068964
                Affiliations
                [1 ]departmentDepartment of Hand Surgery , Helsinki University Hospital and University of Helsinki , Helsinki, Finland
                [2 ]departmentDepartment of Public Health , Ringgold_3835Helsingin Yliopisto , Helsinki, Finland
                Author notes
                [Correspondence to ] Dr Aarni Hannula; aarni.hannula@ 123456helsinki.fi
                Author information
                http://orcid.org/0000-0002-2067-9933
                http://orcid.org/0000-0002-1127-4205
                Article
                bmjopen-2022-068964
                10.1136/bmjopen-2022-068964
                10255115
                37263693
                cbcf4eb9-ab14-4895-9606-bdb622e655e2
                © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:  https://creativecommons.org/licenses/by/4.0/.

                History
                : 12 October 2022
                : 29 March 2023
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100008723, Suomen Lääketieteen Säätiö;
                Award ID: 5302
                Categories
                Surgery
                1506
                1737
                Original research
                Custom metadata
                unlocked

                Medicine
                hand & wrist,neurosurgery,health economics
                Medicine
                hand & wrist, neurosurgery, health economics

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