Featured Research

from universities, journals, and other organizations

Cost-Effectiveness Of Spine Fusion Questioned In Study

Date:
March 3, 2009
Source:
Dartmouth Medical School
Summary:
Rates of spinal fusion have increased by more than 250 percent in the last 15 years. However, is the surgery cost-effective? New research suggests that for patients with spinal stenosis with associated slipped vertebrae, the benefits of the fusion procedure are not enough to offset the costs.

Rates of spinal fusion have increased by more than 250 percent in the last 15 years. However, is the surgery cost-effective? New research published in the December 16 issue of the Annals of Internal Medicine suggests that for patients with spinal stenosis with associated slipped vertebrae, the benefits of the fusion procedure are not enough to offset the costs.

Lumbar spine fusion, in which two or more vertebrae are permanently joined to decrease spine instability, accounts for more than one-third of all back surgeries in the United States. Between 1993 and 2004, the number of spine fusions and the associated costs rose dramatically. In 2004, spine fusion procedures totaled $16.9 billion. (a)

“This study is significant because it is the first to systematically track people’s health care expenditures and health outcomes for these common and costly conditions,” said lead author Anna N.A. Tosteson, ScD. “Given the tremendous increase in the number of spinal fusion procedures, the question of cost-effectiveness has critical implications for the health care system.”

To perform the study, researchers followed patients who participated in the Spine Patient Outcomes Research Trial (SPORT). (b) Specifically, they looked at two conditions, spinal stenosis, which was treated most commonly with laminectomy, and spinal stenosis with slipped vertebrae (spinal stenosis with degenerative spondylolisthesis) most commonly treated with spine fusion.

Of 394 spinal stenosis patients receiving surgery, 320 underwent laminectomy, a procedure that relieves pressure on the nerves through removal of bone and soft tissue. In total, 344 out of 368 surgical patients with stenosis with degenerative spondylolisthesis had spinal fusion.

Two years after surgery, while patients in both groups who had the procedures had better clinical results than those treated non-operatively, the benefits gained in functionality and quality of life were not enough to offset the direct medical costs of fusion, combined with indirect costs such as work-time missed. In contrast, laminectomy for spinal stenosis proved to be effective clinically and economically.

Using the Quality Adjusted Life Year (QALY) scale to measure benefit to patients in comparison to the direct and indirect costs of the surgical procedures, the authors report that stenosis surgery (usually laminectomy) cost about $77,000 per QALY gained. In contrast, surgery for stenosis with slipped vertebrae (usually fusion) cost about $115,000 per QALY gained. In the US, $100,000 is the threshold at which procedures are considered to be cost-effective.

The authors note that their findings are based on measurement of outcomes two years after surgery. Continued follow-up is necessary to determine if cost-effectiveness improves over time.

“Current trends in spine surgery in the United States combined with continued escalation in health care expenditures highlight the importance of understanding the economic value of common surgical procedures,” they write. “Our comprehensive analysis suggests that surgical treatment of spinal stenosis with laminectomy provides reasonable value even over a limited two-year time frame. By contrast, surgery for stenosis associated with degenerative spondylolisthesis is much more costly and will need to show continued health benefit without ongoing costs before it could be considered as being cost-effective.”

In addition to Dr. Tosteson, authors were Jon D. Lurie, MD, MS; Tor D. Tosteson, ScD; Jonathan S. Skinner, PhD, all of Dartmouth and The Dartmouth Institute for Health Policy and Clinical Practice; Harry Herkowitz, MD of William Beaumont Hospital; Todd Albert, MD of the Rothman Institute at Thomas Jefferson University; Scott D. Boden, MD of Emory University; Keith Bridwell, MD, PhD of Washington University; Michael Longley, MD of Nebraska Spine Surgeons; Gunnar B. Andersson, MD, PhD of Rush-Presbyterian; Emily A. Blood, MS and Margaret R. Grove, MS for the SPORT investigators; and James N. Weinstein, DO, MS, for the SPORT Investigators and The Dartmouth Institute for Health Policy and Clinical Practice.


Story Source:

The above story is based on materials provided by Dartmouth Medical School. Note: Materials may be edited for content and length.


Journal Reference:

  1. Tosteson et al. Surgical Treatment of Spinal Stenosis with and without Degenerative Spondylolisthesis: Cost-Effectiveness after 2 Years. Ann Intern Med, 2008; 845-853 [link]

Cite This Page:

Dartmouth Medical School. "Cost-Effectiveness Of Spine Fusion Questioned In Study." ScienceDaily. ScienceDaily, 3 March 2009. <www.sciencedaily.com/releases/2009/03/090303161317.htm>.
Dartmouth Medical School. (2009, March 3). Cost-Effectiveness Of Spine Fusion Questioned In Study. ScienceDaily. Retrieved July 30, 2014 from www.sciencedaily.com/releases/2009/03/090303161317.htm
Dartmouth Medical School. "Cost-Effectiveness Of Spine Fusion Questioned In Study." ScienceDaily. www.sciencedaily.com/releases/2009/03/090303161317.htm (accessed July 30, 2014).

Share This




More Health & Medicine News

Wednesday, July 30, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Generics Eat Into Pfizer's Sales

Generics Eat Into Pfizer's Sales

Reuters - Business Video Online (July 29, 2014) Pfizer, the world's largest drug maker, cut full-year revenue forecasts because generics could cut into sales of its anti-arthritis drug, Celebrex. Fred Katayama reports. Video provided by Reuters
Powered by NewsLook.com
Nigeria Ups Ebola Stakes on 1st Death

Nigeria Ups Ebola Stakes on 1st Death

Reuters - Business Video Online (July 29, 2014) Nigerian authorities have shut and quarantined a Lagos hospital where a Liberian man died of the Ebola virus, the first recorded case of the highly-infectious disease in Africa's most populous economy. David Pollard reports Video provided by Reuters
Powered by NewsLook.com
Running 5 Minutes A Day Might Add Years To Your Life

Running 5 Minutes A Day Might Add Years To Your Life

Newsy (July 29, 2014) According to a new study, just five minutes of running or jogging a day could add years to your life. Video provided by Newsy
Powered by NewsLook.com
Ebola Outbreak Poses Little Threat To U.S.: CDC

Ebola Outbreak Poses Little Threat To U.S.: CDC

Newsy (July 29, 2014) The Ebola outbreak in West Africa poses little threat to Americans, according to officials with the Centers for Disease Control and Prevention. Video provided by Newsy
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins