Cost-Effectiveness Analysis between Percutaneous Endoscopic Lumbar Discectomy (PELD) and Conventional Lumbar Discectomy for Herniated Nucleus Pulposus (HNP)

Abstract

Background: Herniated nucleus pulposus (HNP) occurs when the annulus fibrosus is weakened and torn. Because research is limited, evidence is unclear as to whether percutaneous endoscopic lumbar discectomy (PELD) is superior to conventional surgery for patients with lumbar disc herniation in Thailand, particularly in terms of the costs for all treatment options. Objective: To evaluate from societal and hospital perspectives the clinical outcomes, cost, and cost-effectiveness of PELD, and conventional lumbar discectomy (CLD) in patients with herniated discs. Materials and Methods: The decision tree model was developed to capture the cost and effectiveness for patients with herniated discs under both procedures. Pre- and postoperative evaluations were performed with the Oswestry Disability Index (ODI), visual analog scale (VAS) for health state valuation and pain score. The following surgical variables were collected from medical records and analyzed, surgical time, blood loss, and presence of complications, length of hospital stay, and total days off. The cost of each surgery was collected from the hospital database and references. Results: Statistically significant differences were found in the length of hospital stay, surgical time, blood loss, size of the incision, the number of days off, and the ODI score. The cost of PELD was lower than CLD from the societal perspective but higher than CLD from the hospital perspective. The incremental cost-effectiveness ratio (ICER) was 29,742.92 Baht per ODI score from the societal perspective. Conclusion: PELD seemed to be more cost-effective than CLD in the present study. Keywords: Percutaneous endoscopic lumbar discectomy; Herniated nucleus pulposus; Cost-effectiveness analysis