Special Poster Session 50th International Society for the Study of the Lumbar Spine Annual Meeting 2024

Cost-effectiveness of Condoliase Injection versus Micro-endoscopic Discectomy: A multicenter study (#SP-9f)

Takuya Takahashi 1 , Takashi Hirai 1 , Hiroyuki Sato 2 , Yohei Takahashi 3 , Kota Watanabe 3 , Tomohiro Banno 4 , Kyohei Sakaki 5 , Yuichi Takano 6 , Yawara Eguchi 7 , Yuki Taniguchi 8 , Satoshi Maki 9 , Yasuchika Aoki 10 , Akihiro Hirakawa 2 , Hirotaka Haro 11 , Seiji Ohtori 9
  1. Orthopedic Surgery, Tokyo Medical and Dental University, Bunkyo-ku
  2. Clinical Biostatistics, Tokyo Medical and Dental University, Bunkyo-ku
  3. Orthopedic Surgery, Keio University, Minato-ku
  4. Orthopaedic Surgery, Hamamatsu University, Hamamatsu city
  5. Orthopaedic Surgery, Saiseikai Kawaguchi General Hospital, Kawaguchi city
  6. Orthopedic Surgery, Inanami Spine and Joint Hospital, Shinagawa-Ku
  7. Orthopedic Surgery, Shimoshizu National Hospital, Yotsukaido
  8. Orthopedic Surgery, Tokyo University, Bunkyo-ku
  9. Orthopedic Surgery, Chiba University, Chiba city
  10. Orthopedic Surgery, Eastern Chiba Medical Center, Togane
  11. Orthopedic Surgery, University of Yamanashi, Chuo city

INTRODUCTION

Intradiscal injection of condoliase (chondroitin sulfate ABC endolyase) is a safe treatment w Seiji ith relatively good results. However, the treatment fee for condoliase is extremely low compared with micro-endoscopic discectomy (MED). Regarding cost-effectiveness, few studies have compared the medical economic effect between condoliase injection and surgical treatments, contributing to the debate. Thus, this study aimed to compare the cost-effectiveness of condoliase injection and MED for patients with lumbar disc herniation (LDH).

METHODS

Patients receiving intradiscal condoliase injection (group C) or MED (group M) for LDH at 9 participating centers were included. Basic data, adverse events, treatment costs, hospitalization costs, outpatient-related costs, and the Oswestry disability index (ODI) were collected retrospectively every 3–6 months from before surgery to 1 year after surgery. The analysis period was set to 5 years, and one cycle covered a 6-month period. Using a Markov model, cost-effectiveness was evaluated through simulations that considered discounts for future costs and benefits. Quality-of-life values were calculated from the ODI using a transformation equation. The robustness of the results was evaluated by one-way sensitivity and probabilistic sensitivity analysis.

RESULTS

Cost-effectiveness was evaluated using data from 248 and 114 patients in groups C and M, respectively. The cost in group C was lower than that in group M (587,153 vs 994,664 yen), and the quality-adjusted life years of group C was equal to or higher than that of group M (3.85 vs 3.80), indicating superior cost-effectiveness in group C. In the one-way sensitivity analysis, group C demonstrated superiority in nearly all cases, even when the quality-of-life values and cost at the time of the initial treatment varied. In the probabilistic sensitivity analysis of 1,000 simulations, group C was superior in 95.8% of cases.

DISCUSSION

The results of the cost-effectiveness evaluation revealed that intradiscal condoliase injection is advantageous over MED. Moreover, intradiscal therapy with chondriase injection may be more cost-effective than MED treatment and that technical fees for intradiscal therapy may require re-evaluation.