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

Tosteson, Anna N.A.; Skinner, Jonathan; Tosteson, Tor D.; Lurie, Jon D.; Andersson, Gunnar; Berven, Sigurd; Grove, Margaret R.; Hanscom, Brett; Blood, Emily A.; Weinstein, James Neil

doi:10.1097/brs.0b013e318182e390

Cited by 224 publications

(195 citation statements)

References 13 publications

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“…Whilst five full economic evaluations were identified in the systematic review [20,21,22,23,24], the majority of evaluations were undertaken in conjunction with clinical trials with a lack of published decisions models. A full narrative review of the economic evidence has been published elsewhere [11].…”

Section: Resultsmentioning

confidence: 99%

Cost-effectiveness of different strategies to manage patients with sciatica

Fitzsimmons

Phillips

Bennett

et al. 2014

Pain

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SummaryA model-based economic evaluation demonstrates that stepped approaches based on initial treatment with non-opioids are most likely to represent the most cost-effective regimens for sciatica. 2 AbstractThe aim of this paper is to estimate the relative cost-effectiveness of treatment regimens for managing patients with sciatica. A deterministic model structure was constructed, based on information from the findings from a systematic review of clinical and cost-effectiveness, published sources of unit costs and expert opinion. The assumption was patients presenting with sciatica would be managed through one of three pathways (primary care, stepped approach, immediate referral to surgery).. Results were expressed as incremental cost per patient with symptoms successfully resolved. Analysis also included incremental cost per utility gained over a 12 month period. One-way sensitivity analyses were used to address uncertainty. The model demonstrated that none of the strategies resulted in 100% success. For initial treatments, the most successful regime in the first pathway was non-opioids, with a probability of success of 0.613. In the second pathway, the most successful strategy was non-opioids, followed by biological agents, followed by epidural/nerve block and disc surgery, with a probability of success of 0.996. Pathway 3 (immediate surgery) was not cost-effective. Sensitivity analyses identified that the use of the highest cost estimates results in a similar overall picture. While the estimates of cost per QALY are higher, the economic model demonstrated that stepped approaches based on initial treatment with non-opioids are likely to represent the most cost-effective regimens for the treatment of sciatica. However, development of alternative economic modelling approaches is required.3

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Section: Resultsmentioning

confidence: 99%

Cost-effectiveness of different strategies to manage patients with sciatica

Fitzsimmons

Phillips

Bennett

et al. 2014

Pain

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“…The substantial treatment effect that surgery has been shown to have in prior SPORT studies of patients with stenosis and degenerative spondylolisthesis appears to have been maintained even among this octogenarian population [4][5][6][7] . Although the cost-effectiveness of surgery for stenosis and degenerative spondylolisthesis has been established for the general patient population 19,20 , further studies specifically analyzing cost data and improvement in quality of life will be needed to determine whether such procedures are also truly cost-effective in this elderly and retired population. n…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Surgery for Lumbar Stenosis and Degenerative Spondylolisthesis in the Octogenarian Population

Rihn

Hilibrand

Zhao

et al. 2015

The Journal of Bone and Joint Surgery-American Volume

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“…Cost analyses of numerous spinal surgical techniques for treating various pathologies permeate the spine literature, ranging from the management of degenerative disc disease to scoliosis deformity. [1][2][3]7,10,11,16,21,[24][25][26][27]30,31,38,39,43 Elucidating the elements that affect the cost of spinal surgery can have significant implications for providing safe care in a cost-effective manner. There is a paucity of studies that directly evaluate the cost of surgery for spinal tumors.…”

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confidence: 99%

Costs and readmission rates for the resection of primary and metastatic spinal tumors: a comparative analysis of 181 patients

Lau¹,

Chan²,

Theologis

et al. 2016

SPI

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OBJECTIVE Because the surgical strategies for primary and metastatic spinal tumors are different, the respective associated costs and morbidities associated with those treatments likely vary. This study compares the direct costs and 90-day readmission rates between the resection of extradural metastatic and primary spinal tumors. The factors associated with cost and readmission are identified. METHODS Adults (age 18 years or older) who underwent the resection of spinal tumors between 2008 and 2013 were included in the study. Patients with intradural tumors were excluded. The direct costs of index hospitalization and 90-day readmission hospitalization were evaluated. The direct costs were compared between patients who were treated surgically for primary and metastatic spinal tumors. The independent factors associated with costs and readmissions were identified using multivariate analysis. RESULTS A total of 181 patients with spinal tumors were included (63 primary and 118 metastatic tumors). Overall, the mean index hospital admission cost for the surgical management of spinal tumors was $52,083. There was no significant difference in the cost of hospitalization between primary ($55,801) and metastatic ($50,098) tumors (p = 0.426). The independent factors associated with higher cost were male sex (p = 0.032), preoperative inability to ambulate (p = 0.002), having more than 3 comorbidities (p = 0.037), undergoing corpectomy (p = 0.021), instrumentation greater than 7 levels (p < 0.001), combined anterior-posterior approach (p < 0.001), presence of a perioperative complication (p < 0.001), and longer hospital stay (p < 0.001). The perioperative complication rate was 21.0%. Of this cohort, 11.6% of patients were readmitted within 90 days, and the mean hospitalization cost of that readmission was $20,078. Readmission rates after surgical treatment for primary and metastatic tumors were similar (11.1% vs 11.9%, respectively) (p = 0.880). Prior hospital stay greater than 15 days (OR 6.62, p = 0.016) and diagnosis of lung metastasis (OR 52.99, p = 0.007) were independent predictors of readmission. CONCLUSIONS Primary and metastatic spinal tumors are comparable with regard to the direct costs of the index surgical hospitalization and readmission rate within 90 days. The factors independently associated with costs are related to preoperative health status, type and complexity of surgery, and postoperative course.

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

Abstract: Surgery for IDH was moderately cost-effective when evaluated over 2 years. The estimated economic value of surgery varied considerably according to the method used for assigning surgical costs.

Cited by 224 publications

References 13 publications

Cost-effectiveness of different strategies to manage patients with sciatica

Cost-effectiveness of different strategies to manage patients with sciatica

Effectiveness of Surgery for Lumbar Stenosis and Degenerative Spondylolisthesis in the Octogenarian Population

Costs and readmission rates for the resection of primary and metastatic spinal tumors: a comparative analysis of 181 patients

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