Introduction

Ressearch is needed to identify the most clinically effective and cost-effective management trategies for sciatica. Many treatment modalities for sciatica have been evaluated in placebo-controlled trials (or usual care used as the comparator), and the evidence relating to the direct comparison of numerous treatment modalities is missing. Previous systematic reviews have found evidence for the clinical effectiveness of invasive treatments such as epidural steroid injection (ESI), chemonucleolysis and lumbar discectomy, but found insufficient evidence to advise bed rest, keeping active, analgesia, intramuscular steroid injection or traction. None of the reviews made indirect comparisons across separate trials or examined cost-effectiveness. Previous economic evaluations that have been conducted vary quite considerably, and their value is limited to the perspective and setting for which they were undertaken. We undertook a systematic review of the clinical effectiveness and cost-effectiveness of the different management strategies for sciatica, which tries to address some of these issues. We have also developed a decision-analytic model to assess the cost-effectiveness of different treatment modalities from the UK NHS perspective.