Epidural steroids for lumbosacral radicular syndrome compared to usual care: quality of life and cost utility in general practice.

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.