ArticleJournal of hand surgery global online2025
Value of Early Diagnosis and Treatment of Amyloidosis: A Pilot Study of Synovial Biopsy During Carpal Tunnel Release.
Article in Journal of hand surgery global online, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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Who cites it
3 citing papers in PubMed.
- Development of a Three-Source Convergent Risk Assessment Tool for Amyloidosis Screening in Carpal Tunnel Syndrome Patients.Journal of hand surgery global online · 2026Article
- Tenosynovial and Transverse Carpal Ligament Biopsy for Early Transthyretin Amyloidosis Cardiomyopathy Detection: A Systematic Review and African American Retrospective Cohort Study.Journal of hand surgery global online · 2026Article
- Carpal Tunnel Syndrome and Other Predictors of Amyloidosis.Journal of hand surgery global online · 2026Article
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Authors and funding
7 authors.
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No grant is acknowledged in the PubMed record.
Abstract
Purpose: The purpose of this study is to calculate the value of early diagnosis and treatment of transthyretin amyloidosis with tafamadis prior to the development of the symptoms of heart failure. In this pilot study of 51 patients, we present the validation of a published algorithm for the early identification of patients at risk for amyloidosis via tenosynovial biopsy during carpal tunnel release. In addition, by integrating clinical data from this pilot study with published predictive models, we aim to calculate the value of routine screening biopsies for transthyretin amyloidosis. Methods: Patients presenting for carpal tunnel release surgery had a tenosynovial biopsy collected at the time of surgery. Cost information was gathered from hospital records. In conjunction with published models, five incremental cost effectiveness ratio equations were generated to assess the value of these screening biopsies. Results: Of the 51 biopsied patients, six tested positive for amyloid, and one was started on tafamadis, a disease-modifying medication. Early diagnosis and treatment of patients with New York Heart Association class I (NYHA I) heart failure as opposed to NYHA IV results at a cost of $166,691.49 USD per quality adjusted life year (QALY). When treatment is initiated at NYHA class II stage compared with NYHA class IV, there is a cost of $155,977.22/QALY. For treatment at NYHA class III compared with NYHA class IV, the cost is $75,333.28/QALY. Conclusions: This study validates the utility of previous criteria in identifying patients at high risk for systemic amyloidosis earlier in the disease course. Using the commonly accepted willingness to pay threshold of $50,000/QALY, early initiation of tafamadis does not represent a cost effective intervention. Routine biopsy of patients is not cost effective with the current cost of therapy and positivity rates of amyloidosis screening. Type of study/level of evidence: Prognostic IB.
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