title: Cost-effectiveness of different strategies to manage patients with sciatica.
abstract: The aim of this paper is to estimate the relative cost-effectiveness of treatment regimens for managing patients with sciatica. A deterministic model structure was constructed based on information from the findings from a systematic review of clinical effectiveness and cost-effectiveness, published sources of unit costs, and expert opinion. The assumption was that patients presenting with sciatica would be managed through one of 3 pathways (primary care, stepped approach, immediate referral to surgery). Results were expressed as incremental cost per patient with symptoms successfully resolved. Analysis also included incremental cost per utility gained over a 12-month period. One-way sensitivity analyses were used to address uncertainty. The model demonstrated that none of the strategies resulted in 100% success. For initial treatments, the most successful regime in the first pathway was nonopioids, with a probability of success of 0.613. In the second pathway, the most successful strategy was nonopioids, followed by biological agents, followed by epidural/nerve block and disk surgery, with a probability of success of 0.996. Pathway 3 (immediate surgery) was not cost-effective. Sensitivity analyses identified that the use of the highest cost estimates results in a similar overall picture. While the estimates of cost per quality-adjusted life year are higher, the economic model demonstrated that stepped approaches based on initial treatment with nonopioids are likely to represent the most cost-effective regimens for the treatment of sciatica. However, development of alternative economic modelling approaches is required.
authors.affiliation: Swansea Centre for Health Economics, Swansea University, Swansea, UK North Wales Centre for Primary Care Research, Bangor University, Wrexham, UK Department of Health Sciences, Leicester University, Leicester, UK Sheffield Teaching Hospitals, Sheffield, UK Spinal Research Institute, University of Huddersfield, Huddersfield, UK Patient representative, Betws-y-Coed, UK.
authors.forename: Deborah
authors.initials: D
authors.lastname: Fitzsimmons
authors.forename: Ceri J
authors.initials: CJ
authors.lastname: Phillips
authors.forename: Hayley
authors.initials: H
authors.lastname: Bennett
authors.forename: Mari
authors.initials: M
authors.lastname: Jones
authors.forename: Nefyn
authors.initials: N
authors.lastname: Williams
authors.forename: Ruth
authors.initials: R
authors.lastname: Lewis
authors.forename: Alex
authors.initials: A
authors.lastname: Sutton
authors.forename: Hosam E
authors.initials: HE
authors.lastname: Matar
authors.forename: Nafees
authors.initials: N
authors.lastname: Din
authors.forename: Kim
authors.initials: K
authors.lastname: Burton
authors.forename: Sadia
authors.initials: S
authors.lastname: Nafees
authors.forename: Maggie
authors.initials: M
authors.lastname: Hendry
authors.forename: Ian
authors.initials: I
authors.lastname: Rickard
authors.forename: Claire
authors.initials: C
authors.lastname: Wilkinson
mesh_terms: D015360:Analgesia, Epidural / Q000191:economics / Q000379:methods*; D000700:Analgesics / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D019468:Disease Management; D006801:Humans; D007403:Intervertebral Disc / Q000601:surgery; D018803:Models, Economic; D009407:Nerve Block / Q000191:economics / Q000379:methods*; D059408:Pain Management / Q000191:economics / Q000379:methods*; D026741:Physical Therapy Modalities / Q000191:economics; D012585:Sciatica / Q000191:economics / Q000628:therapy*
chemical_list: D000700:Analgesics
keywords: Cost-effectiveness; Economic model; Sciatica
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