SUBJECT: Washington State HTA Program Draft Evidence Report for Surgery for Symptomatic
Lumbar Radiculopathy
Dear Mr. Morse:
On behalf of the American Academy of Orthopaedic Surgeons (AAOS), American Association of
Neurological Surgeons (AANS), Congress of Neurological Surgeons (CNS), AANS/CNS Joint Section on
Disorders of the Spine and Peripheral Nerves (DSPN), International Society for the Advancement of Spine
Surgery (ISASS), North American Spine Society (NASS) and the Washington State Association of
Neurological Surgeons (WSANS), we appreciate the opportunity to provide feedback on the draft evidence
report related to surgery for symptomatic lumbar radiculopathy. Prepared by RTI International — Evidencebased Practice Center for consideration by the Washington State Health Care Authority (HCA) Health
Technology Assessment (HTA) Program, we have concerns about this review and do not believe that the
findings warrant any change in coverage for surgery for symptomatic lumbar radiculopathy.
Cited Literature Does Not Warrant a Policy Change
The draft evidence report represents a thorough review of the literature. Based on our analysis of the
document and our interpretation of the literature, we do not believe that there is a substantial change in
evidence on this topic and, therefore, we do not support a change to the current coverage policy. Surgery
remains a cornerstone treatment option for patients with lumbar radiculopathy when considering both
therapeutic value and cost-effectiveness. Our specific thoughts on this topic are listed below.
Limitations of Studies from Outside the United States
As we have asserted in previous comments to the HTA program, we are concerned about the inclusion of
studies conducted outside of the United States. Other countries have significantly different health care
systems, patient demographics and socioeconomics, and it is inappropriate to include these studies in this
analysis. Despite repeated reservations about using the non-U.S. studies, a significant portion of the
literature cited in the draft report comes from studies that conducted abroad. For example, of the 22
randomized controlled trials that were reviewed in Efficacy Question 1, only four were performed in the U.S.
With such a high percentage of inapplicable literature as the basis of this draft report, we believe there may
be a fundamental flaw in the conclusions drawn by the HTA, to the detriment of care for U.S. patients.
…
Read full letter here
