Document Detail

Function after spinal treatment, exercise, and rehabilitation: cost-effectiveness analysis based on a randomized controlled trial.
MedLine Citation:
PMID:  21505377     Owner:  NLM     Status:  MEDLINE    
STUDY DESIGN: Cost-effectiveness analysis alongside a factorial randomized controlled trial.
OBJECTIVE: To assess the cost-effectiveness of a rehabilitation program and/or an education booklet each compared with usual care for the postoperative management of patients undergoing discectomy or lateral nerve root decompression surgery.
SUMMARY OF BACKGROUND DATA: There is little knowledge about the cost-effectiveness of postoperative management of patients after spinal surgery.
METHODS: A total of 338 patients were recruited into the study between June 2005 and March 2009. Patients were randomized to rehabilitation only, booklet only, rehabilitation plus booklet, or usual care only. Interactions between booklet and rehabilitation were nonsignificant; hence, we compare booklet versus no booklet and rehabilitation versus no rehabilitation. We adopt an English National Health Service and personal social services perspective. Data on outcomes and costs are based on patient level data from the trial. A 1-year time horizon was used. Outcomes were measured in terms of quality-adjusted life years. Health-related quality of life was reported by patients using the EuroQol-5D (EQ-5D). A comprehensive range of health service contacts were included in the cost analysis.
RESULTS: There were no significant differences in costs or outcomes associated with either intervention. Mean incremental costs and mean quality-adjusted life years gained per patient of booklet versus no booklet were -£87 (95% CI: -£1221 to £1047) and -0.023 (95% CI: -0.068 to 0.023), respectively. Figures for rehabilitation versus no rehabilitation were £160 (95% CI: -£984 to £1304) and 0.002 (95% CI: -0.044 to 0.048), respectively. Neither intervention was cost-effective when compared with the threshold range commonly used to judge whether or not an intervention is cost-effective in the English National Health Service.
CONCLUSION: Cost-effectiveness evidence does not support use of booklet over no booklet or rehabilitation over no rehabilitation for the postoperative management of patients after spinal surgery.
Stephen Morris; Tim P Morris; Alison H McGregor; Caroline J Doré; Konrad Jamrozik
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Spine     Volume:  36     ISSN:  1528-1159     ISO Abbreviation:  Spine     Publication Date:  2011 Oct 
Date Detail:
Created Date:  2011-09-28     Completed Date:  2012-02-15     Revised Date:  2014-02-20    
Medline Journal Info:
Nlm Unique ID:  7610646     Medline TA:  Spine (Phila Pa 1976)     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1807-14     Citation Subset:  IM    
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MeSH Terms
Cost-Benefit Analysis
Decompression, Surgical / adverse effects,  economics*
Disability Evaluation
Diskectomy / adverse effects,  economics*
Exercise Therapy / economics*
Health Care Costs*
Health Knowledge, Attitudes, Practice
Models, Economic
Patient Education as Topic
Postoperative Care / economics*
Postoperative Complications / diagnosis,  economics*,  etiology,  therapy*
Quality of Life
Quality-Adjusted Life Years
Rehabilitation / economics
Spinal Nerve Roots / surgery*
Time Factors
Treatment Outcome
Grant Support
MC_U122886349//Medical Research Council

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

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