• Deborah Fitzsimmons, Ceri J Phillips, Hayley Bennett, Mari Jones, Nefyn Williams, Ruth Lewis, Alex Sutton, Hosam E Matar, Nafees Din, Kim Burton, Sadia Nafees, Maggie Hendry, Ian Rickard, and Claire Wilkinson.
• Swansea Centre for Health Economics, Swansea University, Swansea, UK North Wales Centre for Primary Care Research, Bangor University, Wrexham, UK Department of Health Sciences, Leicester University, Leicester, UK Sheffield Teaching Hospitals, Sheffield, UK Spinal Research Institute, University of Huddersfield, Huddersfield, UK Patient representative, Betws-y-Coed, UK.
• Pain. 2014 Jul 1; 155 (7): 1318-1327.

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 effectiveness and cost-effectiveness, published sources of unit costs, and expert opinion. The assumption was that patients presenting with sciatica would be managed through one of 3 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 nonopioids, with a probability of success of 0.613. In the second pathway, the most successful strategy was nonopioids, followed by biological agents, followed by epidural/nerve block and disk 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 quality-adjusted life year are higher, the economic model demonstrated that stepped approaches based on initial treatment with nonopioids are likely to represent the most cost-effective regimens for the treatment of sciatica. However, development of alternative economic modelling approaches is required. Copyright © 2014 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

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