Cost-effectiveness of full endoscopic versus open discectomy for sciatica
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  • Published on:
    Reply to dr. Arts et al. on Reply on “Cost-effectiveness of full endoscopic versus open discectomy for sciatica” P. Gadjari et al., Br J Sports Med 2022”

    Dear editor,
    On behalf of the PTED study group, we would like to thank the authors for the rapid response on our recently published paper “Cost-effectiveness of Full Endoscopic versus Open Discectomy for Sciatica [1]. The authors mention that they don’t agree with the conclusion of this study and have several comments. Below we will respond to these comments.

    Firstly, the authors suggest that “another study design is needed to investigate cost-effectiveness of PTED above conventional microdiscectomy.” We strongly disagree. The study design was an economic evaluation alongside a pragmatic randomized controlled trial examining the cost-effectiveness of full-endoscopic versus open discectomy for sciatica. An economic evaluation alongside a pragmatic randomised controlled trial is considered an adequate design, because it provides timely information on an intervention’s cost-effectiveness with high internal and sufficient external validity [2]. Furthermore, the study design was peer reviewed by the grant agency (ZONMW in the Netherlands) and we have pre-published our study protocol in an open access, peer reviewed journal [3], supported in a covenant agreement including the Dutch Neurosurgical Society (NVvN), Dutch Orthopedical Society (NOV), Dutch Spine Society and the Dutch Association for patients with low back pain (NVVR).

    Secondly, the authors comment that “costs associated with endoscope equipment and disposables were not included in their cost measur...

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    Conflict of Interest:
    None declared.
  • Published on:
    Reply on “Cost-effectiveness of full endoscopic versus open discectomy for sciatica” P. Gadjari et al., Br J Sports Med 2022
    • Mark Arts, Neurosurgeon Haaglanden Medical Center
    • Other Contributors:
      • Wouter Moojen, Neurosurgeon
      • Ronald Bartels, Neurosurgeon

    We like to commend the authors with the recent publication of the results of a multicenter randomized controlled trial comparing percutaneous transforaminal discectomy (PTED) versus open microdiscectomy in the treatment of patients with symptomatic lumbar disc herniation[1].
    Based on the data of the non-inferiority trial, we fully agree with the authors conclusion that PTED is non-inferior to open microdiscectomy and can therefore be considered as an effective alternative surgical treatment. The improvement of leg pain and low back in the first 3 months is similar between both groups within the non-inferior margin. Patients treated with PTED seem to report less leg pain (mean difference 7.1) and low back pain (mean difference 6.0) at 12 months. However, these differences were small and did not reach the minimal clinically important difference of 20 mm on a VAS score[2].
    In contrast to the BMJ paper, we do not agree with the suggestion stated in the Br J Sports Med paper, that PTED is less costly and more effective for various reasons. Firstly, costs associated with endoscope equipment and disposables were not included in their cost measurements. The direct costs only included time of the operating room, costs of medications and overnight hospital stay. Secondly, the study protocol reported that all PTED procedures should be performed in daycare and the open microdiscectomy patients were admitted in the hospital for one to two days[3]. For adequate comparison of...

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    Conflict of Interest:
    None declared.