Prolonged conservative care versus early surgery in patients with
sciatica from lumbar disc herniation: cost utility analysis alongside a
randomised controlled trial |
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Authors: | Wilbert B van den Hout Wilco C Peul Bart W Koes Ronald Brand Job Kievit Ralph T W M Thomeer |
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Institution: | 1.Department of Medical Decision Making, Leiden University Medical Center, PO Box 9600, 2300RC Leiden, Netherlands;2.Department of Neurosurgery, Leiden University Medical Center;3.Department of Neurosurgery, Medical Center Haaglanden, the Hague, Netherlands;4.Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Netherlands;5.Department of Medical Statistics, Leiden University Medical Center |
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Abstract: | Objective To determine whether the faster recovery after early
surgery for sciatica compared with prolonged conservative care is attained at
reasonable costs.Design Cost utility analysis alongside a randomised controlled
trial.Setting Nine Dutch hospitals.Participants 283 patients with sciatica for 6-12 weeks, caused by
lumbar disc herniation.Interventions Six months of prolonged conservative care compared
with early surgery.Main outcome measures Quality adjusted life years (QALYs) at one
year and societal costs, estimated from patient reported utilities (UK and US
EuroQol, SF-6D, and visual analogue scale) and diaries on costs (healthcare,
patient’s costs, and productivity).Results Compared with prolonged conservative care, early surgery
provided faster recovery, with a gain in QALYs according to the UK EuroQol of
0.044 (95% confidence interval 0.005 to 0.083), the US EuroQol of 0.032 (0.005
to 0.059), the SF-6D of 0.024 (0.003 to 0.046), and the visual analogue scale of
0.032 (−0.003 to 0.066). From the healthcare perspective, early surgery resulted
in higher costs (difference €1819 (£1449; $2832), 95% confidence interval €842
to €2790), with a cost utility ratio per QALY of €41 000 (€14 000 to €430 000).
From the societal perspective, savings on productivity costs led to a negligible
total difference in cost (€−12, €−4029 to €4006).Conclusions Faster recovery from sciatica makes early surgery likely
to be cost effective compared with prolonged conservative care. The estimated
difference in healthcare costs was acceptable and was compensated for by the
difference in absenteeism from work. For a willingness to pay of €40 000 or more
per QALY, early surgery need not be withheld for economic reasons.Trial registration Current Controlled Trials ISRCTN 26872154. |
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