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Surgery for Lumbar Radiculopathy/ Sciatica Final Evidence Report

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Surgery for Lumbar Radiculopathy/ Sciatica Final Evidence Report Surgery for Lumbar Radiculopathy/ Sciatica Final evidence report April 13, 2018 Health Technology Assessment Program (HTA) Washington State Health Care Authority PO Box 42712 Olympia, WA 98504-2712 (360) 725-5126 www.hca.wa.gov/hta [email protected] Prepared by: RTI International–University of North Carolina Evidence-based Practice Center Research Triangle Park, NC 27709 www.rti.org This evidence report is based on research conducted by the RTI-UNC Evidence-based Practice Center through a contract between RTI International and the State of Washington Health Care Authority (HCA). The findings and conclusions in this document are those of the authors, who are responsible for its contents. The findings and conclusions do not represent the views of the Washington HCA and no statement in this report should be construed as an official position of Washington HCA. The information in this report is intended to help the State of Washington’s independent Health Technology Clinical Committee make well-informed coverage determinations. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information (i.e., in the context of available resources and circumstances presented by individual patients). This document is in the public domain and may be used and reprinted without permission except those copyrighted materials that are clearly noted in the document. Further reproduction of those copyrighted materials is prohibited without the specific permission of copyright holders. None of the individuals involved in producing this report reported any financial or non-financial conflicts of interest regarding the topic presented in this report. Acknowledgments The following individuals from the RTI-UNC Evidence-based Practice Center contributed to this report: Lead Investigator: Leila Kahwati, MD, MPH Co-Investigator: Rachel Palmieri Weber, PhD Clinical Advisor: Moe Lim, MD Analysts: Rachel Clark, BA; Katrina Burson, RN, MS Scientific Reviewer: Meera Viswanathan, PhD Library/Document Preparation: Mark Howell, MLS; Loraine Monroe; Laura Small, BA The following individuals independently peer-reviewed the Draft Report; these individuals did not receive any compensation in exchange for their review: Timothy Carey, MD, MPH; Distinguished Professor of Medicine, School of Medicine, University of North Carolina Roger Chou, MD; Professor of Medicine, School of Medicine, Oregon Health & Science University WA – Health Technology Assessment April 13, 2018 Contents List of Appendices .............................................................................................................. ii List of Figures ..................................................................................................................... ii List of Tables ...................................................................................................................... ii List of Abbreviations ........................................................................................................ vii Executive Summary ................................................................................................................ ES-1 Structured Abstract ............................................................................................................. ES-1 ES-1. Background ............................................................................................................. ES-1 ES-2. Methods................................................................................................................... ES-3 ES-3. Results ..................................................................................................................... ES-8 ES-3.1 Literature Yield ................................................................................................. ES-8 ES-3.2 Efficacy ............................................................................................................. ES-8 ES-3.3 Safety .............................................................................................................. ES-23 ES 3.4 Cost ................................................................................................................. ES-28 ES-3.5 Synthesis of Clinical Practice Guidelines ....................................................... ES-30 ES-4. Discussion ............................................................................................................. ES-33 ES-4.1 Summary of the Evidence ............................................................................... ES-33 ES-4.2 Limitations of the Evidence Base ................................................................... ES-35 ES-4.3 Other Related HTAs ....................................................................................... ES-36 ES-4.4 Payer Coverage ............................................................................................... ES-36 ES-4.5 Limitations of this HTA .................................................................................. ES-37 ES-4.6 Ongoing Research and Future Research Needs .............................................. ES-38 ES-5. Conclusion ............................................................................................................ ES-38 Full Technical Report ................................................................................................................... 1 Structured Abstract ................................................................................................................... 1 1. Background ......................................................................................................................... 3 1.1 Condition Description ................................................................................................. 3 1.2 Disease Burden ............................................................................................................ 4 1.3 Technology Description ............................................................................................. 4 1.4 Regulatory Status ........................................................................................................ 5 1.5 Policy Context ............................................................................................................. 6 1.6 Washington State Agency Utilization Data ................................................................. 6 2. Methods............................................................................................................................... 7 2.1 Research Questions and Analytic Framework for Systematic Review of Primary Research Studies .......................................................................................................... 7 2.2 Clinical Practice Guideline Synthesis ....................................................................... 14 3. Results ............................................................................................................................... 15 3.1 Literature Search ....................................................................................................... 15 3.2 Efficacy ..................................................................................................................... 16 3.3 Safety ......................................................................................................................... 74 3.4 Cost and Cost-Effectiveness ...................................................................................... 91 3.5 Clinical Practice Guideline Synthesis ....................................................................... 98 4. Discussion ....................................................................................................................... 107 4.1 Summary of the Evidence ....................................................................................... 107 4.2 Limitations of the Evidence Base ............................................................................ 115 Surgery for Lumbar Radiculopathy/Sciatica: Final evidence report Page i WA – Health Technology Assessment April 13, 2018 4.3 Other related HTAs ................................................................................................. 118 4.4 Selected payer coverage policies ............................................................................. 118 4.5 Limitations of this HTA .......................................................................................... 125 4.6 Ongoing Research and Future Research Needs ...................................................... 126 5. Conclusion ...................................................................................................................... 126 6. References ....................................................................................................................... 127 List of Appendices Appendix A. State of Washington Health Care Authority Utilization Data ............................... A-1 Appendix B. Search Strategy ...................................................................................................... B-1 Appendix C. Additional Methods ............................................................................................... C-1 Appendix D. Evidence Tables ...................................................................................................
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