For Specific Diagnoses, Value of Surgery Increases with Continued Follow-Up
Philadelphia, Pa. (November 14, 2011) – For specific causes of back pain, spinal surgery provides a good value over long-term follow-up, compared to nonsurgical treatment, concludes a report in the November 15th issue of Spine. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.
In patients meeting well-defined diagnostic criteria for spinal disorders, estimates of cost-effectiveness at four years' follow-up are more favorable than at two years. "Following effectiveness and cost patterns over time resulted in improved estimates of surgery's value," according to the new research led by Anna N.A. Tosteson, ScD, of The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Medical School, Lebanon, N.H.
With Longer Follow-up, Economic Benefits of Spine Surgery IncreaseThe researchers analyzed data from the Spine Outcomes Research Trial (SPORT)—one of the largest clinical trials of surgery for spinal disorders. In SPORT, patients meeting criteria for three disorders were either randomly assigned to spinal surgery or nonsurgical treatment or chose their treatment through participation in an observational cohort. The three disorders were degenerative spondylolisthesis (DS), or "slipped" vertebrae caused by bone degeneration; spinal stenosis (SpS), or narrowing of the spinal canal; and intervertebral disc herniation (IDH), or bulging of the disc between two vertebrae.
The cost-effectiveness of spinal surgery was calculated by evaluating the costs of treatment versus the benefits gained in "quality-adjusted life-years" (QALYs)—a standard measure for assessing the value of medical treatments, accounting for both length and quality of life. The analysis included 1,192 with IDH, 634 with SpS, and 601 with DS. In each group, about two-thirds of patients underwent surgery initially or during follow-up. The new study extends the results by reporting on the cost-effectiveness of surgery after a follow-up period of four years.
After two years, surgery led to significant improvements in health for patients with all three conditions. These benefits persisted through four years' follow-up, although the gains were somewhat greater for patients with DS and IDH than for those with SpS.
Longer follow-up also saw an increase in the value of each procedure—as reflected by lower costs per additional QALY gained. The improvement was greatest for patients with DS, who also had the highest initial costs for surgery. The cost per additional QALY gained through surgery for DS decreased from about $115,000 at two years to $64,000 at four years.
Surgery also became more cost-effective for patients with SpS, from $77,000 to $59,000 per QALY; and IDH, from $34,000 to $20,000 per QALY. Thus for all three conditions, surgery became a better value with longer follow-up.
Over the years, rates of spinal surgery have risen rapidly, despite a lack of evidence on how surgery affects important patient outcomes. Begun more than a decade ago, the SPORT study provides important data on the effectiveness of surgery in patients with clearly defined spinal disorders. Early cost-effectiveness data suggested that surgery was a good value for IHD and SpS—less so for expensive DS surgery.
The cost-effectiveness of surgery for DS now approaches that of other commonly accepted medical and surgical treatments. Dr Tosteson and colleagues conclude, "These data provide a basis for promoting fully informed choice for patients with disc herniation or spinal stenosis with or without degenerative spondylolisthesis who face the difficult decision of whether or not to undergo spine surgery."
###About SpineRecognized internationally as the leading journal in its field, Spine (www.spinejournal.com) is an international, peer-reviewed, bi-weekly periodical that considers for publication original articles in the field of spine. It is the leading subspecialty journal for the treatment of spinal disorders. Only original papers are considered for publication with the understanding that they are contributed solely to Spine. According to the latest ISI Science Citation Impact Factor, Spine ranks highest among general orthopaedic journals and subspecialty titles.
About Lippincott Williams & Wilkins Lippincott Williams & Wilkins (LWW) is a leading international publisher for healthcare professionals and students with nearly 300 periodicals and 1,500 books in more than 100 disciplines publishing under the LWW brand, as well as content-based sites and online corporate and customer services.
LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2010 annual revenues of €3.6 billion ($4.7 billion).
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