Objective To assess the costs and cost-effectiveness of percutaneous transforaminal endoscopic discectomy (PTED) compared with open microdiscectomy among patients with sciatica. Methods This economic evaluation was conducted alongside a 12-month multicentre randomised controlled trial with a non-inferiority design, in which patients were randomised to PTED or open microdiscectomy. Patients were aged from 18 to 70 years and had at least 6 weeks of radiating leg pain caused by lumbar disc herniation. Effect measures included leg pain and quality-adjusted life years (QALYs), as derived using the EQ-5D-5L. Costs were measured from a societal perspective. Missing data were multiply imputed, bootstrapping was used to estimate statistical uncertainty, and various sensitivity analyses were conducted to determine the robustness. Results Of the 613 patients enrolled, 304 were randomised to PTED and 309 to open microdiscectomy. Statistically significant differences in leg pain and QALYs were found in favour of PTED 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). Surgery costs were higher for PTED than for open microdiscectomy (ie, €4500/patient vs €4095/patient). All other disaggregate costs as well as total societal costs were lower for PTED than for open microdiscectomy. Cost-effectiveness acceptability curves indicated that the probability of PTED being less costly and more effective (ie, dominant) compared with open microdiscectomy was 99.4% for leg pain and 99.2% for QALYs. Conclusions Our results suggest that PTED is more cost-effective from the societal perspective compared with open microdiscectomy for patients with sciatica. Trial registration number [NCT02602093][1]. Data are available on reasonable request. Statistical analysis code will be made available. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT02602093&atom=%2Fbjsports%2F56%2F18%2F1018.atom

中文翻译：

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全内镜下与开放式椎间盘切除术治疗坐骨神经痛的成本效益


目的 评估坐骨神经痛患者经皮椎间孔内窥镜椎间盘切除术 (PTED) 与开放式显微椎间盘切除术的成本和成本效益。方法 这项经济评估与一项为期 12 个月的多中心随机对照试验（采用非劣效性设计）同时进行，其中患者被随机分配接受 PTED 或开放式显微椎间盘切除术。患者年龄在18岁至70岁之间，因腰椎间盘突出症引起腿部放射痛至少6周。效果测量包括腿部疼痛和质量调整生命年 (QALY)，使用 EQ-5D-5L 得出。成本是从社会角度衡量的。缺失数据被多重估算，自举法用于估计统计不确定性，并进行各种敏感性分析以确定稳健性。结果 在 613 名患者中，304 名被随机分配接受 PTED，309 名被随机分配接受开放式显微椎间盘切除术。 12 个月随访时，发现腿部疼痛和 QALY 存在统计学显着差异，有利于 PTED（腿部疼痛：6.9；95% CI 1.3 至 12.6；QALY：0.040；95% CI 0.007 至 0.074）。 PTED 的手术费用高于开放式显微椎间盘切除术（即 4500 欧元/患者 vs 4095 欧元/患者）。 PTED 的所有其他分类成本以及总社会成本均低于开放式显微椎间盘切除术。成本效益可接受性曲线表明，与开放式显微椎间盘切除术相比，PTED 对于腿部疼痛的成本更低且更有效（即占主导地位）的概率为 99.4%，对于 QALY 为 99.2%。结论 我们的结果表明，从社会角度来看，对于坐骨神经痛患者，PTED 比开放式显微椎间盘切除术更具成本效益。试验注册号[NCT02602093][1]。可根据合理要求提供数据。 将提供统计分析代码。 [1]：/lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT02602093&atom=%2Fbjsports%2F56%2F18%2F1018。原子