Effectiveness and cost-effectiveness of mechanical diagnosis and treatment combined with transforaminal epidural steroid injections for patients on a waiting list for surgery for a chronic lumbar herniated disc: a randomized controlled trial and economic

研究概要

Seventy-two patients with incapacitating sciatica due to lumbar disc herniation were randomized to combination therapy Mechanical Diagnosis & Treatment (MDT) plus transforaminal epidural steroid injections (TESIs) (MDT ± TESIs; n=34) or no added intervention while waiting for surgery (n=38). The primary outcome was undergoing lumbar disc surgery within 12 months (yes/no). Secondary outcomes included leg/back pain (NPRS), function (RMDQ-23), self-perceived recovery (GPE), health-related quality of life (EQ-5D-5L/QALYs), and costs (societal and healthcare). Outcomes were assessed at 4 weeks and at 2, 4, 6, 9, and 12 months. Overall, the results showed markedly fewer surgeries with combination therapy, while clinical outcomes were otherwise similar; healthcare costs and surgery costs were lower with the intervention, and cost-effectiveness was promising—especially from the healthcare perspective. These findings suggest MDT + TESIs can avert many surgeries during the early waitlist period without compromising symptoms or function and may save costs from a payer perspective.