Epidural Steroids for Lumbosacral Radicular Syndrome Compared to Usual Care: Quality of Life and Cost Utility in General Practice

• Published in: Archives of physical medicine and rehabilitation Vol. 96; no. 3; pp. 381 - 387
• Main Authors: Spijker-Huiges, Antje, MD, Vermeulen, Karin, PhD, Winters, Jan C., MD, PhD, van Wijhe, Marten, MD, PhD, van der Meer, Klaas, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-03-2015
• Subjects: Adolescent; Adult; Aged; Cost-Benefit Analysis; Economics; Epidural injections; Family Practice; Female; General practice; Glucocorticoids - administration & dosage; Glucocorticoids - economics; Humans; Injections, Epidural; Lumbosacral Region; Male; Middle Aged; Physical Medicine and Rehabilitation; Quality of Life; Quality-Adjusted Life Years; Radiculopathy - drug therapy; Radiculopathy - economics; Rehabilitation; Sciatica; Syndrome; Treatment Outcome; Triamcinolone - administration & dosage; Triamcinolone - economics; Economics; general practitioner; EQ-5D; lumbosacral radicular syndrome; CI; EuroQol–5 Dimensions; GP; LRS; Medical Outcomes Study 36-Item Short-Form Health Survey; Short-Form–6 Dimensions; quality-adjusted life year; SESI; Quality of life; SF-36; Epidural injections; segmental epidural steroid injection; QALY; General practice; confidence interval; SF-6D; Rehabilitation; Sciatica
• ISSN: 0003-9993; 1532-821X
• DOI: 10.1016/j.apmr.2014.10.017

Abstract Objective To investigate the effect of adding segmental epidural steroid injections (SESIs) to usual care compared with usual care alone on quality of life and cost utility in lumbosacral radicular syndrome (LRS) in general practice. Design A pragmatic randomized controlled trial. Results were analyzed using mixed models. Setting Primary care. Participants Patients (N=50) in the acute phase of LRS. Interventions One epidural injection containing 80mg of triamcinolone in normal saline. Main Outcome Measure Back pain at 4 weeks after the start of the treatment. Results Both groups experienced a significant increase in quality of life in (especially) the physical domains of the Medical Outcomes Study 36-Item Short-Form Health Survey. The intervention group scored significantly better than the control group at certain time points in the physical domain. The differences were small. The cost-utility analysis showed that with a negligible loss of utility (3d in perfect health), societal costs (193,354 euros per quality-adjusted life year lost) would be saved because of more productivity in the intervention group. Conclusions Although the beneficial effects of SESIs are small and the natural course of LRS is predominantly favorable, we think decision makers can consider implementing SESIs in daily practice with the purpose of saving resources. Caution must be taken, and further research should be directed at identifying patient subgroups who might benefit from SESIs, with additional focus on (costs of) complications and adverse effects.