Abstract
BACKGROUND: Lumbosacral radiculopathy, characterized by lower back nerve root pain, is a leading cause of activity limitations and healthcare costs. Acupotomy is a combination of acupuncture and minimally invasive treatment that relieves soft-tissue adhesions, complementing the anti-inflammatory effect of epidural steroid injection (ESI). Although the combination of acupotomy and ESI has shown clinical evidence for pain management, economic evaluations remain scarce. To address this gap, we performed a cost-utility analysis comparing Acupotomy combined with ESI and ESI alone in patients with lumbosacral radiculopathy. METHODS: A randomized controlled trial enrolled patients aged 18-85 years with lumbosacral radiculopathy. Participants were randomized 1:1 to receive either Acupotomy with ESI or ESI single treatment. Utility values were measured using the EuroQol-5 Dimensions-5 Levels questionnaire, and quality-adjusted life year (QALY) were calculated. Direct (medical and non-medical) and indirect costs (productivity loss) were estimated from a societal perspective. The incremental cost-utility ratio was calculated to evaluate the cost-effectiveness of the interventions. RESULTS: Among 50 patients, the mean age was 62.0 years, and 58.0% were females. The overall costs, including direct and indirect costs, were $609 for the Acupotomy with ESI group and $757 for the ESI group. The incremental QALYs for the Acupotomy with ESI group compared to the ESI group were 0.01 QALYs, and the incremental costs were -$147. The incremental cost-utility ratio was -$16,314/QALY, indicating the dominance of combination therapy. Additionally, the average indirect costs for the Acupotomy with ESI and the ESI group were $243 and $498, respectively, representing lower indirect costs in combination therapy. CONCLUSIONS: Acupotomy with ESI treatment was associated with short-term improvements in quality of life and lower total costs over 8 weeks, compared to ESI. These findings should be interpreted with caution, given the limited sample size, short follow-up period, and the restricted generalizability due to a single-center design and specific clinical setting. Nonetheless, this study provides preliminary evidence suggesting the potential cost-effectiveness of acupotomy with ESI for managing lumbosacral radiculopathy. TRIAL REGISTRATION: trial registration number, KCT0006158.