Cost-effectiveness of full endoscopic versus open discectomy for sciatica

Area of Science:

• Spine surgery outcomes
• Health economics in orthopedics
• Minimally invasive spinal procedures

Background:

• Sciatica significantly impacts patient quality of life and healthcare costs.
• Open microdiscectomy is a traditional surgical approach for lumbar disc herniation.
• Percutaneous transforaminal endoscopic discectomy (PTED) offers a minimally invasive alternative.

Purpose of the Study:

• To compare the costs and cost-effectiveness of PTED versus open microdiscectomy for sciatica.
• To evaluate patient-reported outcomes including leg pain and quality-adjusted life years (QALYs).
• To assess the economic impact from a societal perspective.

Main Methods:

• A 12-month multicentre randomized controlled trial with a non-inferiority design.
• Patients aged 18-70 with lumbar disc herniation and radiating leg pain were randomized.
• Societal costs, leg pain, and QALYs (EQ-5D-5L) were measured; data were multiply imputed and analyzed with bootstrapping.

Main Results:

• PTED demonstrated statistically significant improvements in leg pain and QALYs compared to open microdiscectomy at 12 months.
• While PTED had higher surgery costs, total societal costs were lower.
• Cost-effectiveness acceptability curves showed a >99% probability of PTED being dominant (less costly, more effective).

Conclusions:

• PTED is a more cost-effective treatment option for sciatica compared to open microdiscectomy.
• The findings support PTED as a superior approach from both clinical and economic perspectives.
• This study provides strong evidence for the adoption of PTED in clinical practice.