Cost-effectiveness of intradiscal injection with condoliase versus microendoscopic discectomy for lumbar disc herniation: a retrospective multicenter study

Intradiscal condoliase injection has been described as a safe treatment with relatively favorable results. In Japan, the direct medical cost of intradiscal condoliase injection is significantly lower than that of microendoscopic discectomy (MED). The objective of this study was to assess the cost-effectiveness of condoliase injection compared to MED in patients with lumbar disc herniation (LDH). This retrospective study included patients who received either an intradiscal condoliase injection or MED for LDH at nine participating centers. Pretreatment magnetic resonance imaging revealed that the patients had subligamentous-type herniation. A Markov model was used to evaluate cost-effectiveness. The robustness of the results was assessed using one-way and probabilistic sensitivity analyses. The cost-effectiveness was assessed using data from 229 patients treated with condoliase injection and 98 patients treated with MED. Condoliase injection had a significantly lower mean direct cost compared to MED, while the quality-adjusted life years were equal, indicating similar effectiveness and potential for cost savings. A one-way sensitivity analysis revealed that condoliase injection remained superior in nearly all scenarios. A probabilistic sensitivity analysis revealed that condoliase injection was cost-saving compared to MED in 92.6% of cases. These findings indicate that intradiscal condoliase injection is cost-saving compared to MED for the treatment of LDH.