Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 3: assessment of economic outcome

Abstract

A comprehensive economic analysis generally involves the calculation of indirect and direct health costs from a societal perspective as opposed to simply reporting costs from a hospital or payer perspective. Hospital charges for a surgical procedure must be converted to cost data when performing a cost-effectiveness analysis. Once cost data has been calculated, quality-adjusted life year data from a surgical treatment are calculated by using a preference-based health-related quality-of-life instrument such as the EQ-5D. A recent cost-utility analysis from a single study has demonstrated the long-term (over an 8-year time period) benefits of circumferential fusions over stand-alone posterolateral fusions. In addition, economic analysis from a single study has found that lumbar fusion for selected patients with low-back pain can be recommended from an economic perspective. Recent economic analysis, from a single study, finds that femoral ring allograft might be more cost-effective compared with a specific titanium cage when performing an anterior lumbar interbody fusion plus posterolateral fusion.

Keywords: ALIF = anterior lumbar inter-body fusion; CCR = cost-to-charge ratio; CMS = Center for Medicare and Medicaid Services; CPT = Current Procedural Terminology; DRG = Diagnosis-Related Group; FRA = femoral ring allograft; HR-QOL = health-related quality of life; ICBG = iliac crest bone graft; ICD = International Classification of Diseases; ICER = incremental cost-effectiveness ratio; LOS = length of hospital stay; MIS = minimally invasive surgery; ODI = Oswestry Disability Index; QALY = quality-adjusted life year; SEK = Swedish kronor; SF-36 = 36-Item Short Form Health Survey; SPORT = Spine Patient Outcomes Research Trial; TC = titanium cage; TDR = total lumbar disc replacement; TLIF = transforaminal lumbar interbody fusion; UK = United Kingdom; VAS = visual analog scale; cost-effectiveness; fusion; lumbar spine; outcomes; practice guidelines; rhBMP-2 = recombinant human bone morphogenetic protein–2.