Pravesh S Gadjradj1, Biswadjiet S Harhangi2, Maurits W van Tulder3, Wilco C Peul4, Esther W de Bekker-Grob5,6. 1. Department of Neurosurgery, Park MC, Hoofdweg 90, Rotterdam, the Netherlands. p.gadjradj@erasmusmc.nl. 2. Department of Neurosurgery, Erasmus MC: University Medical Center Rotterdam, Rotterdam, the Netherlands. 3. Department Movement Sciences, Faculty Behavioral and Movement Sciences and, Amsterdam Movement Science Research Institute, Vrije Universiteit, Amsterdam, the Netherlands. 4. Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands. 5. Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, the Netherlands. 6. Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands.
Abstract
PURPOSE: Multiple surgical techniques are practiced to treat sciatica caused by lumbar disk herniation. It is unknown which factors surgeons find important when offering certain surgical techniques. The objective of this study is threefold: 1) determine the relative weight surgeons place on various characteristics of sciatica treatment, 2) determine the trade-offs surgeons make between these characteristics and 3) identify preference heterogeneity for sciatica treatment. METHODS: A discrete choice experiment was conducted among members of two international neurosurgical organizations. Surgeons were asked on their preferences for surgical techniques using specific scenarios based on five characteristics: effectiveness on leg pain, risk of recurrent disk herniation, duration of postoperative back pain, risk of complications and recovery period. RESULTS: Six-hundred and forty-one questionnaires were filled in, the majority by neurosurgeons. All characteristics significantly influenced the preferences of the respondents. Overall, the risk of complications was the most important characteristic in the decision to opt-in or opt-out for surgery (35.7%). Risk of recurrent disk herniation (19.6%), effectiveness on leg pain (18.8%), postoperative back pain duration (13.5%) and length of recovery period (12.4%) followed. Four latent classes were identified, which was partly explained by the tenure of the surgeon. Surgeons were willing to trade-off 57.8% of effectiveness on leg pain to offer a treatment that has a 1% complication risk instead of 10%. CONCLUSION: In the context of this discrete choice experiment, it is shown that neurosurgeons consider the risk of complications as most important when a surgical technique is offered to treat sciatica, while the risk of recurrent disk herniation and effectiveness are also important factors. Neurosurgeons were prepared to trade off substantial amounts of effectiveness to achieve lower complication rates.
PURPOSE: Multiple surgical techniques are practiced to treat sciatica caused by lumbar disk herniation. It is unknown which factors surgeons find important when offering certain surgical techniques. The objective of this study is threefold: 1) determine the relative weight surgeons place on various characteristics of sciatica treatment, 2) determine the trade-offs surgeons make between these characteristics and 3) identify preference heterogeneity for sciatica treatment. METHODS: A discrete choice experiment was conducted among members of two international neurosurgical organizations. Surgeons were asked on their preferences for surgical techniques using specific scenarios based on five characteristics: effectiveness on leg pain, risk of recurrent disk herniation, duration of postoperative back pain, risk of complications and recovery period. RESULTS: Six-hundred and forty-one questionnaires were filled in, the majority by neurosurgeons. All characteristics significantly influenced the preferences of the respondents. Overall, the risk of complications was the most important characteristic in the decision to opt-in or opt-out for surgery (35.7%). Risk of recurrent disk herniation (19.6%), effectiveness on leg pain (18.8%), postoperative back pain duration (13.5%) and length of recovery period (12.4%) followed. Four latent classes were identified, which was partly explained by the tenure of the surgeon. Surgeons were willing to trade-off 57.8% of effectiveness on leg pain to offer a treatment that has a 1% complication risk instead of 10%. CONCLUSION: In the context of this discrete choice experiment, it is shown that neurosurgeons consider the risk of complications as most important when a surgical technique is offered to treat sciatica, while the risk of recurrent disk herniation and effectiveness are also important factors. Neurosurgeons were prepared to trade off substantial amounts of effectiveness to achieve lower complication rates.
Authors: Sean M Barber; Sanjay Konakondla; Jonathan Nakhla; Jared S Fridley; Jimmy Xia; Adetokunbo A Oyelese; Albert E Telfeian; Ziya L Gokaslan Journal: J Neurosurg Spine Date: 2019-11-08
Authors: Steven J Kamper; Raymond W J G Ostelo; Sidney M Rubinstein; Jorm M Nellensteijn; Wilco C Peul; Mark P Arts; Maurits W van Tulder Journal: Eur Spine J Date: 2014-01-18 Impact factor: 3.134
Authors: F Reed Johnson; Emily Lancsar; Deborah Marshall; Vikram Kilambi; Axel Mühlbacher; Dean A Regier; Brian W Bresnahan; Barbara Kanninen; John F P Bridges Journal: Value Health Date: 2013 Jan-Feb Impact factor: 5.725
Authors: Pravesh S Gadjradj; Maurits W van Tulder; Clemens M F Dirven; Wilco C Peul; B Sanjay Harhangi Journal: Neurosurg Focus Date: 2016-02 Impact factor: 4.047
Authors: Wilco C H Jacobs; Mark P Arts; Maurits W van Tulder; Sidney M Rubinstein; Marienke van Middelkoop; Raymond W Ostelo; Arianne P Verhagen; Bart W Koes; Wilco C Peul Journal: Eur Spine J Date: 2012-07-20 Impact factor: 3.134