A large number of people suffer from severe back pain and spend a lot of money to treat the problem. Now, researchers at Rush University Medical Center have delved into an important question dealing with the cost of such treatment- Is the surgery cost effective?
The study has revealed that for patients with spinal stenosis, a laminectomy, which is the surgical removal of some soft bone and tissue, is of reasonable value.
On the other hand, for patients with spinal stenosis with associated slipped vertebrae, the benefits of spinal fusion surgery may not be enough to offset costs.
Rush was one of 13 sites throughout America and the only Chicago site that followed patients in the Spine Patient Outcomes Research Trial (SPORT).
"This study is significant because it is the first to systematically track people's health care expenditures and health outcomes. More than 650,000 surgical procedures are performed annually for back pain in the United States with costs exceeding 20 billion dollars.
Whether this investment provides good value is largely unknown," said Dr. Gunnar Andersson, former chairman of the department of Orthopedics at Rush and study investigator.
For the study, the researchers focussed on two conditions, spinal stenosis that is treated most commonly with laminectomy-a procedure where orthopaedic surgeons remove the portion of the vertebral bone called the lamina and soft tissue to relieve pressure on the nerves in the spine.
And the second condition is spinal stenosis with slipped vertebrae also known as spinal stenosis with degenerative spondylolisthesis, which is most commonly treated with spine fusion surgery.
The randomized, controlled trial of surgery versus non-operative treatment had over 3,900 patients as participants. While 320 patients underwent laminectomy, 344 patients had spinal fusion.
Researchers used the Quality Adjusted Life Year (QALY) scale to measure benefit to patients in comparison to the direct and indirect costs of the surgical procedures over a two-year period after surgery.
The researchers calculated that stenosis surgery using laminectomy cost is 77,000 dollars per QALY gained.
In contrast, spinal fusion surgery for stenosis with slipped vertebrae cost about 115,000 dollars per QALY gained. In the U.S., 100,000 dollars is the threshold at which procedures are considered to be cost effective.
After the initial two-year analysis, it was found that decompressive surgery without fusion for spinal stenosis offers good value and that fusion surgery for spondylolithesis offers less value for its cost than most accepted interventions.
A definitive assessment of cost effectiveness awaits longer-term outcome data, which will be analyzed further as the trial continues.
"With the number of spine surgery cases in the U.S. increasing and the rising costs of health care expenditures, it is extremely important for us to understand the economic value of common surgical procedures. Cost effectiveness is a critical component of providing patients with quality care," said Andersson.
The study is published in a recent issue of the Annals of Internal Medicine.