Cost-effectiveness of primarily surgical versus primarily conservative treatment of acute and subacute radiculopathies due to intervertebral disc herniation from the Swiss perspective

AIMS OF THE STUDY: To assess the cost-effectiveness ofprimarily surgical treatment (PST) versus primarily conservative treatment(PCT) in adults with intermediate severity, acute or subacute, lumbar radicularsyndrome due to intervertebral disc herniation. METHODS: A decision analyticmodel from healthcare system and societal perspectives was used to compareoutcomes and costs of PST with those of PCT (physiotherapy, epidural injectionand medication). Treatment pathways and quality of life were obtained frompublished clinical trials. Costs were derived from Swiss health insuranceclaims data. Swiss clinical experts provided information on use of medicationand physiotherapy. The main outcome of interest was incremental cost perquality-adjusted-life-year (QALY) gained over a period of 2 years. Costs andQALYs gained were discounted from the second year, at a rate of 2% per year. RESULTS:In the base-case analysis from a healthcare system perspective, over 2 years,PST compared with PCT led to 0.0634 additional QALYs per person, at anadditional net cost of CHF 7198 per person. The corresponding incremental costeffectiveness ratio (ICER) amounted to CHF 113 396 per QALY gained. From asocietal perspective the ICER was CHF 70 711 per QALY gained. ICERs were subjectto substantial uncertainty because of limitations in available data. CONCLUSION:A PST approach, when compared with PCT, may be cost effective from a societalperspective based on a willingness-to-pay threshold of CHF 100 000 per QALYgained. However, it is less likely to be cost effective from the perspective ofthe Swiss healthcare system. More research is needed to understand thelong-term economic implications among this patient group.