Cost-effectiveness of different strategies to manage patients with sciatica

Deborah Fitzsimmons, Ceri J. Phillips, Hayley Bennett, Mari Jones, Nefyn Williams, Ruth Lewis, Alex Sutton, Hosam E. Matar, Nafees Din, Kim Burton, Sadia Nafees, Maggie Hendry, Ian Rickard, Claire Wilkinson

Research output: Contribution to journalArticle

10 Citations (Scopus)

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 and cost-effectiveness, published sources of unit costs and expert opinion. The assumption was patients presenting with sciatica would be managed through one of three 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 non-opioids, with a probability of success of 0.613. In the second pathway, the most successful strategy was non-opioids, followed by biological agents, followed by epidural/nerve block and disc 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 QALY are higher, the economic model demonstrated that stepped approaches based on initial treatment with non-opioids are likely to represent the most cost-effective regimens for the treatment of sciatica. However, development of alternative economic modelling approaches is required.
Original languageEnglish
Pages (from-to)1318-1327
Number of pages10
JournalPain
Volume155
Issue number7
DOIs
Publication statusPublished - 1 Jul 2014

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Sciatica
Cost-Benefit Analysis
Costs and Cost Analysis
Economic Models
Economic Development
Quality-Adjusted Life Years
Nerve Block
Expert Testimony
Biological Factors
Therapeutics
Uncertainty
Primary Health Care
Referral and Consultation

Cite this

Fitzsimmons, D., Phillips, C. J., Bennett, H., Jones, M., Williams, N., Lewis, R., ... Wilkinson, C. (2014). Cost-effectiveness of different strategies to manage patients with sciatica. Pain, 155(7), 1318-1327. https://doi.org/10.1016/j.pain.2014.04.008
Fitzsimmons, Deborah ; Phillips, Ceri J. ; Bennett, Hayley ; Jones, Mari ; Williams, Nefyn ; Lewis, Ruth ; Sutton, Alex ; Matar, Hosam E. ; Din, Nafees ; Burton, Kim ; Nafees, Sadia ; Hendry, Maggie ; Rickard, Ian ; Wilkinson, Claire. / Cost-effectiveness of different strategies to manage patients with sciatica. In: Pain. 2014 ; Vol. 155, No. 7. pp. 1318-1327.
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Fitzsimmons, D, Phillips, CJ, Bennett, H, Jones, M, Williams, N, Lewis, R, Sutton, A, Matar, HE, Din, N, Burton, K, Nafees, S, Hendry, M, Rickard, I & Wilkinson, C 2014, 'Cost-effectiveness of different strategies to manage patients with sciatica', Pain, vol. 155, no. 7, pp. 1318-1327. https://doi.org/10.1016/j.pain.2014.04.008

Cost-effectiveness of different strategies to manage patients with sciatica. / Fitzsimmons, Deborah; Phillips, Ceri J.; Bennett, Hayley; Jones, Mari; Williams, Nefyn; Lewis, Ruth; Sutton, Alex; Matar, Hosam E.; Din, Nafees; Burton, Kim; Nafees, Sadia; Hendry, Maggie; Rickard, Ian; Wilkinson, Claire.

In: Pain, Vol. 155, No. 7, 01.07.2014, p. 1318-1327.

Research output: Contribution to journalArticle

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AU - Fitzsimmons, Deborah

AU - Phillips, Ceri J.

AU - Bennett, Hayley

AU - Jones, Mari

AU - Williams, Nefyn

AU - Lewis, Ruth

AU - Sutton, Alex

AU - Matar, Hosam E.

AU - Din, Nafees

AU - Burton, Kim

AU - Nafees, Sadia

AU - Hendry, Maggie

AU - Rickard, Ian

AU - Wilkinson, Claire

PY - 2014/7/1

Y1 - 2014/7/1

N2 - 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 and cost-effectiveness, published sources of unit costs and expert opinion. The assumption was patients presenting with sciatica would be managed through one of three 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 non-opioids, with a probability of success of 0.613. In the second pathway, the most successful strategy was non-opioids, followed by biological agents, followed by epidural/nerve block and disc 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 QALY are higher, the economic model demonstrated that stepped approaches based on initial treatment with non-opioids are likely to represent the most cost-effective regimens for the treatment of sciatica. However, development of alternative economic modelling approaches is required.

AB - 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 and cost-effectiveness, published sources of unit costs and expert opinion. The assumption was patients presenting with sciatica would be managed through one of three 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 non-opioids, with a probability of success of 0.613. In the second pathway, the most successful strategy was non-opioids, followed by biological agents, followed by epidural/nerve block and disc 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 QALY are higher, the economic model demonstrated that stepped approaches based on initial treatment with non-opioids are likely to represent the most cost-effective regimens for the treatment of sciatica. However, development of alternative economic modelling approaches is required.

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Fitzsimmons D, Phillips CJ, Bennett H, Jones M, Williams N, Lewis R et al. Cost-effectiveness of different strategies to manage patients with sciatica. Pain. 2014 Jul 1;155(7):1318-1327. https://doi.org/10.1016/j.pain.2014.04.008