Costs and Cost-effectiveness of Epidural Steroids for Acute Lumbosacral Radicular Syndrome in General Practice

Autor: Klaas van der Meer, Jan C. Winters, Antje Spijker-Huiges, Marten van Wijhe, Karin M. Vermeulen
Přispěvatelé: Methods in Medicines evaluation & Outcomes research (M2O), Life Course Epidemiology (LCE)
Rok vydání: 2014
Předmět:
Male
Cost effectiveness
Cost-Benefit Analysis
SCIATICA
medicine.medical_treatment
Anti-Inflammatory Agents
costs
lumbosacral radicular syndrome
Triamcinolone
RECOMMENDATIONS
law.invention
Disability Evaluation
Cost of Illness
Randomized controlled trial
steroid injections
DISK
law
Back pain
Single-Blind Method
Orthopedics and Sports Medicine
Pain Measurement
general practice
Lumbar Vertebrae
Middle Aged
Low back pain
NUCLEUS PULPOSUS
medicine.anatomical_structure
BACK-PAIN
Anesthesia
Acute Disease
Female
medicine.symptom
INTERVENTION
Intervertebral Disc Displacement
Adult
medicine.medical_specialty
Injections
Epidural
Lumbar vertebrae
NERVE-ROOT
Drug Costs
pragmatic RCT
MANAGEMENT
medicine
Humans
cost-effectiveness
radiculopathy
Sciatica
business.industry
Epidural steroid injection
CORTICOSTEROID INJECTIONS
productivity loss
Back Pain
Physical therapy
Neurology (clinical)
business
Lumbosacral joint
pain treatment
Zdroj: SPINE, 39(24), 2007-2012. LIPPINCOTT WILLIAMS & WILKINS
ISSN: 0362-2436
DOI: 10.1097/brs.0000000000000597
Popis: Study Design. A pragmatic, randomized, controlled, single-blinded trial in Dutch general practice.Objective. Assessing the costs and cost-effectiveness of adding segmental epidural steroid injections to care as usual in radiculopathy in general practice.Summary of Background Data. Lumbosacral radicular syndrome (radiculopathy) is a benign, generally self-limiting but painful condition caused by a herniated lumbar intervertebral disc, which results in an inflammatory process around the nerve root. Segmental epidural steroid injections could lessen pain. Low back pain and sciatica form a large financial burden on national health care systems. Improving pain treatment could lower costs to society by diminishing loss of productivity.Methods. Patients with acute radiculopathy were included by general practitioners. All patients received usual care. Patients in the intervention group received one segmental epidural steroid injection containing 80 mg of triamcinolone as well. Follow-up was performed using postal questionnaires at 2, 4, 6, 13, 26, and 52 weeks. Main outcomes were pain, disability and costs. Economic evaluation was performed from a societal perspective with a time horizon of 1 year.Results. Sixty-three patients were included in the analysis. Mean total costs were (sic)4414 or $5985 in the intervention group and (sic)5121 or $6943 in the control group. This difference was mostly due to loss of productivity. The point estimate for the incremental cost-effectiveness ratio was -(sic)730 or -$990 (1-point diminishment on the numerical rating scale back pain score in 1 patient in the course of 1 yr would save (sic)730 or $990). Bootstrapping showed a 95% confidence interval of -(sic)4476 to (sic)951 or -$6068 to $1289. The cost-effectiveness acceptability curve showed that without additional investment the probability that epidural steroids are cost-effective is more than 80%.Conclusion. The effect on pain and disability of epidural steroids in lumbosacral radicular syndrome is small but significant, and at lower costs with no reported complications or adverse effects. Segmental epidural steroid injections could be considered by policy makers as an additional treatment option.
Databáze: OpenAIRE
Externí odkaz: