Document Detail


Cost-effectiveness of lumbar discectomy for the treatment of herniated intervertebral disc.
MedLine Citation:
PMID:  8724089     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
STUDY DESIGN: A cost-effectiveness analysis of lumbar discectomy based on existing efficacy data and newly gathered cost data. OBJECTIVES: For patients with herniated lumbar discs unresponsive to conservative management, surgery relieves pain more rapidly but at higher costs than continued medical therapy. We evaluated the cost-effectiveness of lumbar discectomy for these patients. SUMMARY OF BACKGROUND DATA: Effectiveness estimates were based on the results of a published trial of 126 herniated disc patients randomized to surgical or nonsurgical treatment. Quality of life values were based on a study of 83 subjects with low back pain. Treatment costs for herniated discs were estimated from insurance data for 372 patients treated surgically and 1,803 treated medically. METHODS: Efficacy results were weighted by quality of life values to estimate the quality-adjusted benefit of surgery. Cost-effectiveness was calculated in dollars per quality-adjusted year of life gained. Supplemental data sources for cost and effectiveness provided ranges for sensitivity analyses. RESULTS: Surgery increased average quality-adjusted life expectancy by 0.43 years during the decade following treatment, a benefit similar to extending a healthy life by 5 months. Reimbursements for surgical patients were $12,550 more than for medical patients. Nondiscounted and 5% discounted cost-effectiveness were $29,200 and $33,900 per quality-adjusted year of life gained. Supplemental analyses confirmed the basecase effectiveness estimates but suggested that the cost of discectomy was overestimated. Replacing the main cost estimate with one based on HMO patients lowered discectomy's cost to $12,000 per quality-adjusted life-year gained. CONCLUSION: For carefully selected patients with herniated discs, surgical discectomy is a cost-effective treatment. Discectomy's favorable cost-effectiveness results from its substantial effect on quality of life and moderate costs.
Authors:
A D Malter; E B Larson; N Urban; R A Deyo
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S.    
Journal Detail:
Title:  Spine     Volume:  21     ISSN:  0362-2436     ISO Abbreviation:  Spine     Publication Date:  1996 May 
Date Detail:
Created Date:  1996-10-03     Completed Date:  1996-10-03     Revised Date:  2010-03-24    
Medline Journal Info:
Nlm Unique ID:  7610646     Medline TA:  Spine (Phila Pa 1976)     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1048-54; discussion 1055     Citation Subset:  IM    
Affiliation:
University of Washington School of Public Health, Seattle, USA.
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MeSH Terms
Descriptor/Qualifier:
Cost-Benefit Analysis
Costs and Cost Analysis
Data Interpretation, Statistical
Diskectomy / economics*
Female
Health Maintenance Organizations / economics
Humans
Insurance, Health, Reimbursement
Intervertebral Disk Displacement / surgery*
Lumbar Vertebrae / surgery*
Male
Middle Aged
Quality of Life
Quality-Adjusted Life Years
Risk Management
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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