Chemonucleolysis versus surgical discectomy for sciatica secondary to lumbar disc herniation. A cost and quality-of-life evaluation.
The objective of this study was to evaluate and compare the cost and effects on quality of life [using quality-adjusted life years (QALYs)] of 2 treatments for sciatica secondary to lumbar disc herniation: chemonucleolysis and surgical discectomy. The design involved a combination of decision analysis and Rosser index, with assessment of probabilities from long term clinical series. Utility was based on patients' subjective assessment using a simplified self-administered Health Measurement Questionnaire (HMQ). 146 patients from 7 hospitals were enrolled, 2 to 3 months after chemonucleolysis or surgery. The end-points used were cost and QALYs for each intervention, every year for years 1 to 7. At the time of analysis (1990), the total cost of surgical discectomy was FF15,400, compared with FF8000 for chemonucleolysis. After 1 year, and including the costs of reoperation for failure and relapse and long term medical costs for the non-reoperated unsatisfactory results, discectomy costs were almost 40% higher than those of chemonucleolysis. Ratios remain unchanged after 7 years. QALY results reveal an additional benefit of 52 days of good health associated with chemonucleolysis.
Launois
R
R
Public Health Laboratory, University of Bobigny, France.
Henry
B
B
Marty
J R
JR
Gersberg
M
M
Lassale
C
C
Benoist
M
M
Goehrs
J M
JM
D003362:Cost-Benefit Analysis; D017586:Diskectomy / Q000191:economics*; D005500:Follow-Up Studies; D006801:Humans; D007404:Intervertebral Disc Chemolysis / Q000191:economics*; D007405:Intervertebral Disc Displacement / Q000150:complications* / Q000191:economics; D017063:Outcome Assessment, Health Care; D011788:Quality of Life; D012585:Sciatica / Q000209:etiology / Q000601:surgery* / Q000628:therapy*; D013997:Time Factors