The clinical effectiveness and cost-effectiveness of management strategies for sciatica: systematic review and economic model

Lewis, Ruth; Williams, Nefyn; Matar, Hosam E; Din, Nafees Ud; Fitzsimmons, Deborah; Phillips, Ceri; Jones, Michael David; Sutton, Alex J.; Burton, Kim; Nafees, Sadia; Hendry, Maggie; Rickard, I; Chakraverty, R; Wilkinson, Claire

doi:10.3310/hta15390

Cited by 83 publications

(91 citation statements)

References 151 publications

(921 reference statements)

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“…Detailed search methods including search protocols, search strategies and results of study selection are available as part of the full report of the systematic review [11].…”

Section: Systematic Reviewmentioning

confidence: 99%

“…The base-case analysis incorporated best available assumptions and data derived from the results of the systematic review, with sensitivity analysis undertaken to evaluate the sensitivity of the results to changes in important assumptions and input parameter values. The considerable level of uncertainty (seen with the wide variation in confidence intervals around the point estimates of global effect, as reported in the systematic review of clinical effectiveness [11]) restricted the development of a probabilistic model which could fully assess and quantify uncertainty.…”

Section: Systematic Reviewmentioning

confidence: 99%

“…This meant that level 2 categorisations were used in the economic model. A full report of the MTC methods are reported elsewhere [11]. [16].…”

Section: Systematic Reviewmentioning

confidence: 99%

“…The influence of this assumption on modelled results was tested in sensitivity analysis. The systematic review of clinical evidence [11] were used to generate a list of potential treatments For sciatica and guidance was consulted (e.g. MAP of Medicine).…”

Section: Systematic Reviewmentioning

confidence: 99%

“…Based on the findings of a systematic review of both clinical and cost-effectiveness [11], the aim of this paper is to estimate the relative cost-effectiveness of different treatment regimens for managing patients with sciatica. A further aim is to inform future economic modelling approaches to assess the relative cost-effectiveness of treatment regimes for sciatica.…”

Section: Introductionmentioning

confidence: 99%

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Cost-effectiveness of different strategies to manage patients with sciatica

Fitzsimmons

Phillips

Bennett

et al. 2014

Pain

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SummaryA model-based economic evaluation demonstrates that stepped approaches based on initial treatment with non-opioids are most likely to represent the most cost-effective regimens for sciatica. 2 AbstractThe 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.3

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“…Detailed search methods including search protocols, search strategies and results of study selection are available as part of the full report of the systematic review [11].…”

Section: Systematic Reviewmentioning

confidence: 99%

Section: Systematic Reviewmentioning

confidence: 99%

“…This meant that level 2 categorisations were used in the economic model. A full report of the MTC methods are reported elsewhere [11]. [16].…”

Section: Systematic Reviewmentioning

confidence: 99%

Section: Systematic Reviewmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Cost-effectiveness of different strategies to manage patients with sciatica

Fitzsimmons

Phillips

Bennett

et al. 2014

Pain

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Efficacy and harms of orally, intramuscularly or intravenously administered glucocorticoids for sciatica: A systematic review and meta‐analysis

Shaheed

Maher

Buchbinder

et al. 2020

European Journal of Pain

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Background Sciatica can be a debilitating condition and there is limited guidance on the use of glucocorticoids administered via the oral, intramuscular or intravenous route for this condition. These represent viable treatment options in the primary care setting. Objective To evaluate the evidence on efficacy and harms of oral, IM and IV glucocorticoid administration for sciatica. Databases and data treatment MEDLINE, EMBASE, CENTRAL, CINAHL, PsycINFO (inception to October 2018) were searched for randomised placebo‐controlled trials evaluating oral, IV or IM glucocorticoid administration for sciatica. Two authors extracted outcomes data. Continuous pain and disability outcomes were converted to a 0 (no pain/disability) to 100 (worst pain/disability) scale. Data were pooled using a random effects model. Overall quality of evidence was assessed using GRADE. Primary outcomes were leg pain and disability. Primary follow‐up period was the immediate‐term (<2 weeks from administration). We also considered adverse events. Results Nine trials were eligible. One study [n = 27] provided low quality evidence of a small reduction in disability with early administration of oral prednisone (within 1 week); MD −13.4 [−23.3, −3.5] but not for pain MD −2.5 [−16.9, 11.9]. There was low quality evidence from one study [n = 78] of moderate reduction in disability and small reduction in pain with early (within 72 hr of symptom onset) single intramuscular administration of methylprednisolone acetate; MD −24.5 [−38.8, −10.2] and −14.0 [−27.4, −0.6], respectively. There were no immediate‐term benefits with IV administration. Conclusion The effects of glucocorticoids on immediate‐term leg pain or disability are uncertain. Future large high quality trials are needed to resolve this uncertainty.

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