A. Lafuma et al., A PRAGMATIC COST-EFFECTIVENESS STUDY OF ROUTINE EPIDURAL CORTICOSTEROID INJECTIONS FOR LUMBOSCIATIC SYNDROME REQUIRING INHOSPITAL MANAGEMENT, Revue du rhumatisme, 64(10), 1997, pp. 549-555
A multicenter randomized study was conducted using a pragmatic approac
h to evaluate the benefits and costs of routine epidural corticosteroi
d injections for the treatment of lumbosciatic syndrome requiring inho
spital management, The primary evaluation criterion was whether other
treatments were required after one to three injections, The 108 patien
ts were randomly allocated to treatment with or without routine epidur
al corticosteroids. Rest and a nonsteroidal antiinflammatory drug were
used in all patients, The two groups were comparable at baseline exce
pt for a larger proportion of males in the routine epidural corticoste
roid group, Patients in the routine epidural corticosteroid group were
more likely to require other treatments, but the difference was only
of borderline significance after adjustment for gender, Results showed
that physicians based their treatment decisions primarily on whether
an improvement in the clinical status of the patient was apparent at t
he second visit, None of the other factors studied influenced treatmen
t decisions, Clinical efficacy criteria were identical in the two grou
ps, Hospital costs contributed most of the total cost, and the mean co
st was higher in the routine epidural corticosteroid group, These data
suggest that adding an epidural injection as a first-line treatment t
o rest and a nonsteroidal antiinflammatory drug for the treatment of l
umbosciatic syndrome requiring inhospital management results in additi
onal costs and no gain in efficacy.