Percutaneous transforaminal endoscopic discectomy is more cost-effective than open microdiscectomy for patients with sciatica, according to a new study.
The study, “Cost-effectiveness of full endoscopic versus open discectomy for sciatica,” was first published online on February 20,2022 in the British Journal of Sports Medicine.
For their study, the research team collected economic data for both procedures and also measured effectiveness. The study was a 12-month multi-center randomized controlled trial. The study enrolled patients ranging in age from 18 to 70 years and who had been experiencing at least 6 weeks of radiating leg pain caused by lumbar disc herniation.
The multi-center and international research team measured patients’ leg pain, quality-adjusted life years (QALY) were measured and costs.
A total of 613 patients were included in the study, 304 were randomized to percutaneous transforaminal endoscopic discectomy and 309 to open microdiscectomy.
The researchers reported statistically significant differences in leg pain and QALYs in favor of percutaneous transforaminal endoscopic discectomy 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).
Interestingly, the study evidence found that surgery costs were higher for percutaneous transforaminal endoscopic discectomy than for open microdiscectomy. But, noted the American and Netherland research teams, from a societal cost standpoint, all other disaggregate costs were lower for percutaneous transforaminal endoscopic discectomy than for open microdiscectomy.
Finally, the teams found that cost-effectiveness acceptability curves also supported the probability that percutaneous transforaminal endoscopic discectomy is less costly and more effective than open microdiscectomy.
The study authors include 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, Mauritis W. van Tulder, and Biswadjiet S. Harhandi.
The researchers are associated with Weill Cornell Brain and Spine Center, New York-Presbyterian/Weil Cornell Medicine New York, New York, Erasmus MC, Rotterdam, The Netherlands, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands, Amsterdam Movement Sciences research institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands, Elisabeth-TweeSteden Ziekenhuis, Tilburg, The Netherlands, Leiden University Medical Center, Leiden, The Netherlands, Rijnstate, Arnhem, The Netherlands, and Aarhus University Hospital, Aarhus, Denmark.
Aside from potential savings, there is the benefit to the patient. Mind you, endoscopic proficiency is difficult, but it provides much less blood loss, a shorter operating time, and quicker recovery for the patients. Studies have also shown that in the long run, the results for the patient were equivalent via either surgical method. As always, the success lies in the skill and hands of the surgeon.