OP06 Percutaneous Transforaminal Endoscopic Discectomy: From Insufficient Evidence To Reimbursement

Introduction The standard surgical technique for lumbosacral radicular syndrome in the Netherlands is open microdiscectomy (OM). An alternative technique, preferred by some Dutch physicians, percutaneous transforaminal endoscopic discectomy (PTED). However, 2006 National Health Care Institute (Zorginstituut Netherland [ZIN]) concluded that available evidence was insufficient, and a high quality randomized controlled trial (RCT) needed to assess cost-effectiveness of PTED compared OM. relevant physician group agreed with this conclusion, but they were unable perform RCT due lack funding treatment costs. Methods In 2012, introduced conditional reimbursement (CR) program give patients earlier access promising treatments. Researchers, collaboration physicians patients, submitted grant proposal 2016 Ministry approved CR PTED. Due decision, insurance companies obliged reimburse participating PTED-study (NCT02602093). Organization Research Development (ZonMw) also provided research fund PTED-study. total, 682 adult greater than 10 weeks radiating pain, or 6 excessive pain an indication surgery included. After 4 years 5 months completed. Results Outcomes published studies unpublished used HTA reassessment. showed noninferior OM regards leg (Visual Analogue Scale: mean difference (MD) -0.73; 95% confidence interval [CI] -5.04, 3.59), functional status (Oswestry Disability Index: MD -2.07; CI -3.61, -0.53), rate complications (relative risk 0.45; 0.18, 1.12) after (GRADE level ‘moderate’). Furthermore was, surgeons’ learning-curve, cost-effective. Conclusions This project successful now reimbursed as part healthcare package. order maintain care clinical practice, safeguards should be developed (including appropriate training surgeons). example shows programs are essential treatments without ‘wealthy’ manufacturers. Additionally, all stakeholders make CR-study successful.