@article {Gadjradj1018, author = {Pravesh Shankar Gadjradj and Hana M Broulikova and Johanna M van Dongen and Sidney M Rubinstein and Paul R Depauw and Carmen Vleggeert and Ankie Seiger and Wilco C Peul and Job L van Susante and Maurits W van Tulder and Biswadjiet S Harhangi}, title = {Cost-effectiveness of full endoscopic versus open discectomy for sciatica}, volume = {56}, number = {18}, pages = {1018--1025}, year = {2022}, doi = {10.1136/bjsports-2021-104808}, publisher = {British Association of Sport and Excercise Medicine}, abstract = {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, {\texteuro}4500/patient vs {\texteuro}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.Data are available on reasonable request. Statistical analysis code will be made available.}, issn = {0306-3674}, URL = {https://bjsm.bmj.com/content/56/18/1018}, eprint = {https://bjsm.bmj.com/content/56/18/1018.full.pdf}, journal = {British Journal of Sports Medicine} }