Cost-Utility study for operative methods in spinal surgery

Balaska, Dimitra and Pollalis, Yannis and Dimogerontas, George and Bitsori, Zoi and Karaferis, Dimitrios and Malisiova, Vasiliki (2020): Cost-Utility study for operative methods in spinal surgery.

Abstract

AIM: The purpose of the present study is to evaluate the quality of life (QoL) of patients with spinal problems before and after surgery with the use of the EQ-5D-5L health status questionnaire.

MATERIALS - METHODS: The research is based on primary data collection of 314 patients who completed the questionnaires at three different times: a) preoperatively; that is, after completion of conservative treatment which involved medication, physiotherapy, etc., b) ten days postoperatively and c) immediately after the first post-operative month.

RESULTS: Out of the 314 patients, aged between 34 and 79 years (mean age 52±15,07) who participated in this study, 172 were males (54,8%) and 142 females (45,2%). 77,71% of the patients suffered from a herniated intervertebral disc and 22,29% from spondylolisthesis in the lumbar region. Total improvement of the quality of life (QoL) in our study was on average 0,59 QALYs at 10 days and 0,82 QALYs at 30 days. The total average direct cost of these surgical interventions amounted to 9341,86±4042,53 euro while the index of cost-utility for the sample population was estimated to be 15870,16 euro/ QALY at 10 days. This index decreased considerably to 11867,14 euro/ QALY at 30 days after the surgical intervention since the average benefit in QALYs increased and the QoL improved.

CONCLUSIONS: The evaluation of the data of this study was highlighted the high degree of effectiveness of each surgery applied to treat the symptomatology of patients . All the statistical tests applied to the sample showed a very significant improvement of all variables used by the questionnaire for all intervals evaluated after surgery. Lastly, there has also been a very large improvement in the overall QoL of patients.

• Item Type: MPRA Paper
• Language: English
• Keywords: Utility, Cost, Quality of Life, Spinal Column
• Subjects: I - Health, Education, and Welfare > I1 - Health > I15 - Health and Economic Development

References

Adogwa, O., Parker, S. L., Davis, B. J., Aaronson, O., Devin, C., Cheng, J. S., & McGirt, M. J. (2011). Cost-effectiveness of transforaminal lumbar interbody fusion for Grade I degenerative spondylolisthesis: Clinical article. Journal of Neurosurgery: Spine, 15(2). https://doi.org/10.3171/2011.3.SPINE10562

Boos, N. (2009). The impact of economic evaluation on quality management in spine surgery. European Spine Journal, 18(SUPPL. 3). https://doi.org/10.1007/s00586-009-0939-3

Civelek, E., Cansever, T., Kabatas, S., Kircelli, A. K., Yilmaz, C., Musluman, M., Ofluoglu, D., & Caner, H. (2012). Comparison of effectiveness of facet joint injection and radiofrequency denervation in chronic low back pain. Turkish Neurosurgery, 22(2). https://doi.org/10.5137/1019-5149.JTN.5207-11.1

D’Orazio, F., Gregori, L. M., & Gallucci, M. (2015). Spine epidural and sacroiliac joints injections - When and how to perform. European Journal of Radiology, 84(5). https://doi.org/10.1016/j.ejrad.2014.05.039

Ramos-Goñi, J. M., Craig, B. M., Oppe, M., Ramallo-Fariña, Y., Pinto-Prades, J. L., Luo, N., & Rivero-Arias, O. (2018). Handling Data Quality Issues to Estimate the Spanish EQ-5D-5L Value Set Using a Hybrid Interval Regression Approach. Value in Health, 21(5). https://doi.org/10.1016/j.jval.2017.10.023

Räsänen, P., Öhman, J., Sintonen, H., Ryynänen, O. P., Koivisto, A. M., Blom, M., & Roine, R. P. (2006). Cost-utility analysis of routine neurosurgical spinal surgery. Journal of Neurosurgery: Spine, 5(3). https://doi.org/10.3171/spi.2006.5.3.204

Solberg, T. K., Olsen, J. A., Ingebrigtsen, T., Hofoss, D., & Nygaard, Ø. P. (2005). Health-related quality of life assessment by the EuroQol-50 can provide cost-utility data in the field of low-back surgery. European Spine Journal, 14(10). https://doi.org/10.1007/s00586-005-0898-2

Tosteson, A. N. A., Skinner, J. S., Tosteson, T. D., Lurie, J. D., Andersson, G. B., Berven, S., Grove, M. R., Hanscom, B., Blood, E. A., & Weinstein, J. N. (2008). The cost effectiveness of surgical versus nonoperative treatment for lumbar disc herniation over two years: Evidence from the Spine Patient Outcomes Research Trial (SPORT). Spine, 33(19). https://doi.org/10.1097/BRS.0b013e318182e390

Tosteson, A. N. A., Tosteson, T. D., Lurie, J. D., Abdu, W., Herkowitz, H., Andersson, G., Albert, T., Bridwell, K., Zhao, W., Grove, M. R., Weinstein, M. C., & Weinstein, J. N. (2011). Comparative Effectiveness Evidence From the Spine Patient Outcomes Research Trial. Spine, 36(24). https://doi.org/10.1097/brs.0b013e318235457b

van den Akker, M. E., Arts, M. P., van den Hout, W. B., Brand, R., Koes, B. W., & Peul, W. C. (2011). Tubular diskectomy vs conventional microdiskectomy for the treatment of lumbar disk-related sciatica: Cost utility analysis alongside a double-blind randomized controlled trial. Neurosurgery, 69(4). https://doi.org/10.1227/NEU.0b013e31822578f6

van Hout, B., Janssen, M. F., Feng, Y. S., Kohlmann, T., Busschbach, J., Golicki, D., Lloyd, A., Scalone, L., Kind, P., & Pickard, A. S. (2012). Interim scoring for the EQ-5D-5L: Mapping the EQ-5D-5L to EQ-5D-3L value sets. Value in Health, 15(5). https://doi.org/10.1016/j.jval.2012.02.008

Weinstein, J. N., Tosteson, A. N. A., Tosteson, T. D., Lurie, J. D., Abdu, W. A., Mirza, S. K., Zhao, W., Morgan, T. S., & Nelson, E. C. (2014). The SPORT value compass: Do the extra costs of undergoing spine surgery produce better health benefits? Medical Care, 52(12). https://doi.org/10.1097/MLR.0000000000000250

Yfantopoulos, J. (2001). The Greek version of the EuroQol (EQ-5D) instrument. Archives of Hellenic Medicine, 18(2).

Zygourakis, C. C., & Kahn, J. G. (2015). Cost-effectiveness research in neurosurgery. In Neurosurgery Clinics of North America (Vol. 26, Issue 2). https://doi.org/10.1016/j.nec.2014.11.008