Cost-effectiveness of full endoscopic versus open discectomy for sciatica

British Journal of Sports Medicine, vol. 56, pp. 1018–1025

Abstract

OBJECTIVE: To assess the costs and cost-effectiveness of percutaneous transforaminal endoscopic discectomy (PTED) compared with open microdiscectomy among patients with sciatica. METHODS: This economic evaluation was conducted alongside a 12-month multicentre randomised controlled trial with a non-inferiority design, in which patients were randomised to PTED or open microdiscectomy. Patients were aged from 18 to 70 years and had at least 6 weeks of radiating leg pain caused by lumbar disc herniation. Effect measures included leg pain and quality-adjusted life years (QALYs), as derived using the EQ-5D-5L. Costs were measured from a societal perspective. Missing data were multiply imputed, bootstrapping was used to estimate statistical uncertainty, and various sensitivity analyses were conducted to determine the robustness. RESULTS: Of the 613 patients enrolled, 304 were randomised to PTED and 309 to open microdiscectomy. Statistically significant differences in leg pain and QALYs were found in favour of PTED at 12 months follow-up (leg pain: 6.9; 95% CI 1.3 to 12.6; QALYs: 0.040; 95% CI 0.007 to 0.074). Surgery costs were higher for PTED than for open microdiscectomy (ie, €4500/patient vs €4095/patient). All other disaggregate costs as well as total societal costs were lower for PTED than for open microdiscectomy. Cost-effectiveness acceptability curves indicated that the probability of PTED being less costly and more effective (ie, dominant) compared with open microdiscectomy was 99.4% for leg pain and 99.2% for QALYs. CONCLUSIONS: Our results suggest that PTED is more cost-effective from the societal perspective compared with open microdiscectomy for patients with sciatica. TRIAL REGISTRATION NUMBER: NCT02602093.

Authors 11

1. Pravesh Shankar Gadjradj

   Erasmus MC · Weill Cornell Medicine

   Affiliation as printed

   Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian/Weil Cornell Medicine New York, New York, USA

   Department of Neurosurgery, Erasmus MC, Rotterdam, The Netherlands

2. Hana Marie Broulíková

   Amsterdam Public Health · Vrije Universiteit Amsterdam

   Affiliation as printed

   Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands

3. Johanna Maria van Dongen

   Amsterdam Public Health · Vrije Universiteit Amsterdam

   Affiliation as printed

   Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands

4. Sidney M. Rubinstein

   Amsterdam Movement Sciences · Vrije Universiteit Amsterdam

   Affiliation as printed

   Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences research institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands

5. Paul R. A. M. Depauw

   Elisabeth-TweeSteden Ziekenhuis

   Affiliation as printed

   Department of Neurosurgery, Elisabeth-TweeSteden Ziekenhuis, Tilburg, The Netherlands

6. Carmen Vleggeert Aachen Department of Neurosurgery, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands

7. Ankie Seiger

   Amsterdam Movement Sciences · Vrije Universiteit Amsterdam

   Affiliation as printed

   Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences research institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands

8. Wilco C. Peul Aachen Department of Neurosurgery, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands

9. Job LC van Susante

   Rijnstate Hospital

   Affiliation as printed

   Department of Orthopedic Surgery, Rijnstate, Arnhem, The Netherlands

10. Maurits W. van Tulder

    Aarhus University Hospital · Amsterdam Movement Sciences · Vrije Universiteit Amsterdam

    Affiliation as printed

    Department of Physiotherapy & Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark

    Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences research institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands

11. Biswadjiet Sanjay Harhangi corresponding

    Erasmus MC

    Affiliation as printed

    Department of Neurosurgery, Erasmus MC, Rotterdam, The Netherlands b.s.harhangi@erasmusmc.nl

    Department of Neurosurgery, Erasmus MC, Rotterdam, Zuid-Holland, Netherlands