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Cost-effectiveness of different strategies to manage patients with sciatica.
Fitzsimmons, Deborah; Phillips, Ceri J; Bennett, Hayley; Jones, Mari; Williams, Nefyn; Lewis, Ruth; Sutton, Alex; Matar, Hosam E; Din, Nafees; Burton, Kim; Nafees, Sadia; Hendry, Maggie; Rickard, Ian; Wilkinson, Claire.
Afiliação
  • Fitzsimmons D; 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 ; 155(7): 1318-1327, 2014 Jul.
Article em En | MEDLINE | ID: mdl-24726924
The 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.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Ciática / Analgesia Epidural / Análise Custo-Benefício / Manejo da Dor / Analgésicos / Bloqueio Nervoso Tipo de estudo: Health_economic_evaluation / Prognostic_studies / Systematic_reviews Limite: Humans Idioma: En Ano de publicação: 2014 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Ciática / Analgesia Epidural / Análise Custo-Benefício / Manejo da Dor / Analgésicos / Bloqueio Nervoso Tipo de estudo: Health_economic_evaluation / Prognostic_studies / Systematic_reviews Limite: Humans Idioma: En Ano de publicação: 2014 Tipo de documento: Article