The clinical and cost-effectiveness of corticosteroid injection versus night splints for carpal tunnel syndrome (INSTINCTS trial): an open-label, parallel group, randomised controlled trial

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234 patients with carpal tunnel syndrome were randomized to a single injection of 20mg methylprednisolone acetate or 6 weeks of nightly splinting. Patients were assessed primarily for outcomes on the Boston Carpal Tunnel Questionnaire at 6 weeks and 6 months. In addition, cost-utility analysis was performed. Results for the BCTQ Symptom Severity Score and Functional Status Score significantly favoured the CS injection group compared to the nightly splinting group at 6 weeks, while differences at 6 months were not significant. On a 6-month timeline, CS injection demonstrated an incremental cost-effectiveness ratio of £4193 per QALY gained compared to nightly splinting, with a 76% probability of being considered cost-effective at a willingness-to-pay threshold of £20,000.