Cost-effectiveness of full endoscopic versus open discectomy for sciatica

Pravesh Shankar Gadjradj; Hana M. Broulikova; Johanna M. van Dongen; Sidney M. Rubinstein; Paul R. Depauw; Carmen Vleggeert; Ankie Seiger; Wilco C. Peul; Job L. van Susante; Maurits W. van Tulder; Biswadjiet S. Harhangi

doi:10.1136/bjsports-2021-104808

Cost-effectiveness of full endoscopic versus open discectomy for sciatica

Pravesh Shankar Gadjradj, Hana M. Broulikova, Johanna M. van Dongen, Sidney M. Rubinstein, Paul R. Depauw, Carmen Vleggeert, Ankie Seiger, Wilco C. Peul, Job L. van Susante, Maurits W. van Tulder, Biswadjiet S. Harhangi^*

^*Corresponding author for this work

Research output: Contribution to Journal › Article › Academic › peer-review

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.

Original language	English
Article number	104808
Pages (from-to)	1018–1025
Number of pages	8
Journal	British Journal of Sports Medicine
Volume	56
Issue number	18
Early online date	20 Feb 2022
DOIs	https://doi.org/10.1136/bjsports-2021-104808
Publication status	Published - 5 Sept 2022

Bibliographical note

Funding Information:
This study was funded by ZonMw, The Netherlands Organisation for Health Research and Development (project number 837004013).

Publisher Copyright:
© Author(s) (or their employer(s)) 2022.

Funding

This study was funded by ZonMw, The Netherlands Organisation for Health Research and Development (project number 837004013).

Funders	Funder number
Dutch Health Insurance Board
Marjon Nuijten
ZonMw	837004013

Access to Document

10.1136/bjsports-2021-104808

Persistent URL (handle)

Copy link address

Cite this

Gadjradj, P. S., Broulikova, H. M., van Dongen, J. M., Rubinstein, S. M., Depauw, P. R., Vleggeert, C., Seiger, A., Peul, W. C., van Susante, J. L., van Tulder, M. W., & Harhangi, B. S. (2022). Cost-effectiveness of full endoscopic versus open discectomy for sciatica. British Journal of Sports Medicine, 56(18), 1018–1025. Article 104808. https://doi.org/10.1136/bjsports-2021-104808

@article{f251280607bf4e3e8aa75bc02cf23bb9,

title = "Cost-effectiveness of full endoscopic versus open discectomy for sciatica",

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.",

author = "Gadjradj, {Pravesh Shankar} and Broulikova, {Hana M.} and {van Dongen}, {Johanna M.} and Rubinstein, {Sidney M.} and Depauw, {Paul R.} and Carmen Vleggeert and Ankie Seiger and Peul, {Wilco C.} and {van Susante}, {Job L.} and {van Tulder}, {Maurits W.} and Harhangi, {Biswadjiet S.}",

note = "Funding Information: This study was funded by ZonMw, The Netherlands Organisation for Health Research and Development (project number 837004013). Publisher Copyright: {\textcopyright} Author(s) (or their employer(s)) 2022.",

year = "2022",

month = sep,

day = "5",

doi = "10.1136/bjsports-2021-104808",

language = "English",

volume = "56",

pages = "1018–1025",

journal = "British Journal of Sports Medicine",

issn = "1473-0480",

publisher = "BMJ Publishing Group",

number = "18",

}

TY - JOUR

T1 - Cost-effectiveness of full endoscopic versus open discectomy for sciatica

AU - Gadjradj, Pravesh Shankar

AU - Broulikova, Hana M.

AU - van Dongen, Johanna M.

AU - Rubinstein, Sidney M.

AU - Depauw, Paul R.

AU - Vleggeert, Carmen

AU - Seiger, Ankie

AU - Peul, Wilco C.

AU - van Susante, Job L.

AU - van Tulder, Maurits W.

AU - Harhangi, Biswadjiet S.

N1 - Funding Information: This study was funded by ZonMw, The Netherlands Organisation for Health Research and Development (project number 837004013). Publisher Copyright: © Author(s) (or their employer(s)) 2022.

PY - 2022/9/5

Y1 - 2022/9/5

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=85125758364&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85125758364&partnerID=8YFLogxK

U2 - 10.1136/bjsports-2021-104808

DO - 10.1136/bjsports-2021-104808

M3 - Article

C2 - 35185010

SN - 1473-0480

VL - 56

SP - 1018

EP - 1025

JO - British Journal of Sports Medicine

JF - British Journal of Sports Medicine

IS - 18

M1 - 104808

ER -

Cost-effectiveness of full endoscopic versus open discectomy for sciatica

Abstract

Bibliographical note

Funding

Access to Document

Persistent URL (handle)

Other files and links

Fingerprint

Cite this