Spinal Surgery Becomes More Cost-Effective Over Time

A new study concludes that for specific causes of back pain, spinal surgery provides a good value (over long-term follow-up) compared to nonsurgical treatment.

Researchers at Dartmouth Medical School (DHMC; Lebanon, NH, USA) analyzed four year follow-up data from the Spine Outcomes Research Trial (SPORT), one of the largest clinical trials of surgery for spinal disorders; 2,427 patients meeting study criteria for degenerative spondylolisthesis (DS, 601 patients), spinal stenosis (SpS, 634 patients), and intervertebral disc herniation (IDH, 1,192 patients), were either randomly assigned to spinal surgery or nonsurgical treatment, or chose their treatment through participation in an observational cohort; in each group, about two-thirds of patients underwent surgery initially or during follow-up. The cost-effectiveness of spinal surgery was calculated by evaluating the costs of treatment versus the benefits gained in quality-adjusted life-years (QALYs).

The results showed 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, with cost per additional QALY gained through surgery decreasing from about USD 115,000 at two years to USD 64,000 at four years. Surgery also became more cost-effective for patients with SpS, from USD 77,000 to USD 59,000 per QALY; and for IDH, reduced from USD 34,000 to USD 20,000 per QALY. The study was published in the November 15, 2011, issue of Spine.

“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,” concluded lead author Anna Tosteson, ScD, and colleagues at the Dartmouth Institute for Health Policy and Clinical Practice.

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