Health economic evaluation in lumbar spinal fusion: a systematic literature review anno 2005

Abstract

The goal of this systematic literature review was to assess the evidence for cost-effectiveness of various surgical techniques in lumbar spinal fusion in conformity with the guidelines provided by the Cochrane Back Review Group. As new technology continuously emerges and divergent directions in clinical practice are present, economic evaluation is needed in order to facilitate the decision-makers' budget allocations. NHS Economic Evaluation Database, MEDLINE, EMBASE and Cochrane Library were searched. Two independent reviewers (one clinical content expert and one economic content expert) applied the eligibility criteria. A list of criteria for methodological quality assessment was established by merging the criteria recommended by leading health economists with the criteria recommended by the Cochrane Back Review Group. The two reviewers independently scored the selected literature and the disagreement was resolved by means of consensus following discussion. Key data were extracted and the level of evidence concluded. Seven studies were eligible; these studies reflected the diversified choices of economic methodology, study populations (diagnosis), outcome measures and comparators. At the conclusion of quality assessment, the methodological quality of three studies was judged credible. Two studies investigated posteolateral fusion (PLF) +/- instrumentation in different populations: one investigated non-specific low back pain and one investigated degenerative stenosis + spondylolisthesis. Both studies reflected that cost-effectiveness of instrumentation in PLF is not convincing. The third study concerned the question of circumferential vs anterior lumbar interbody fusion and found a non-significant difference between the techniques. In conclusion, the literature is limited and, in view of the fact that the clinical effects are statistically synonymous, it does not support the use of high-cost techniques. There is a great potential for improvement of methodological quality in economic evaluations of lumbar spinal fusion and further research is imperative.

Comparative Effectiveness Evidence From the Spine Patient Outcomes Research Trial

“…Other economic analyses have addressed the value of spinal fusion for various populations or lumbar discectomy for IDH but have not reported outcomes using the recommended effectiveness measure, QALYs. 4,14,29,31 Although our study addressed many of these shortcomings, several limitations warrant mention. First, our study relied on patient self-report of resource use and work/ activity limitations over time.…”

Comparison of lifetime incremental cost:utility ratios of surgery relative to failed medical management for the treatment of hip, knee and spine osteoarthritis modelled using 2-year postsurgical values

“…8,12,13,39,[41][42][43] Furthermore, most have made many assumptions and forecasted the lifetime ICUR in a manner similar to those made in the present study. In addition, different values (e.g., QALYs, revision rates) are often assigned in the various reported models, and thus valid cross-comparisons within subgroups of a broader population are often not possible.…”

The Cost Effectiveness of Surgical Versus Nonoperative Treatment for Lumbar Disc Herniation Over Two Years

“…To date, relative to spinal fusion, the economic value of surgery for disc herniation has received relatively little attention 23. Our comprehensive analysis suggests that surgical treatment of herniated disc represents a reasonably cost-effective health care intervention when compared with other common health care interventions.…”