Cost-effectiveness of lumbar fusion and nonsurgical treatment for chronic low back pain in the Swedish lumbar spine study: A multicenter, randomized, controlled trial from the Swedish Lumbar Spine Study Group
2004 (English)In: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 29, no 4, 421-434 p.Article in journal (Refereed) Published
Study Design. A cost-effectiveness study was performed from the societal and health care perspectives. Objective. To evaluate the costs-effectiveness of lumbar fusion for chronic low back pain (CLBP) during a 2-year follow-up. Summary of Background Data. A full economic evaluation comparing costs related to treatment effects in patients with CLBP is lacking. Patients and Methods. A total of 284 of 294 patients with CLBP for at least 2 years were randomized to either lumbar fusion or a nonsurgical control group. Costs for the health care sector ( direct costs), and costs associated with production losses ( indirect costs) were calculated. Societal total costs were identified as the sum of direct and indirect costs. Treatment effects were measured using patient global assessment of improvement, back pain ( VAS), functional disability (Owestry), and return to work. Results. The societal total cost per patient ( standard deviations) in the surgical group was significantly higher than in the nonsurgical group: Swedish kroner (SEK) 704,000 ( 254,000) vs. SEK 636,000 ( 208,000). The cost per patient for the health care sector was significantly higher for the surgical group, SEK 123,000 ( 60,100) vs. 65,200 ( 38,400) for the control group. All treatment effects were significantly better after surgery. The incremental cost-effectiveness ratio ( ICER), illustrating the extra cost per extra effect unit gained by using fusion instead of nonsurgical treatment, were for improvement: SEK 2,600 ( 600 - 5,900), for back pain: SEK 5,200 ( 1,100 - 11,500), for Oswestry: SEK 11,300 ( 1,200 - 48,000), and for return to work: SEK 4,100 ( 100 21,400). Conclusion. For both the society and the health care sectors, the 2-year costs for lumbar fusion was significantly higher compared with nonsurgical treatment but all treatment effects were significantly in favor of surgery. The probability of lumbar fusion being cost-effective increased with the value put on extra effect units gained by using surgery.
Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2004. Vol. 29, no 4, 421-434 p.
chronic low back pain, degenerative disc disease, lumbar spinal fusion, RCT, prospective randomized controlled study, cost-effectiveness analysis, sensitivity analysis, societal perspective, health care perspective
IdentifiersURN: urn:nbn:se:liu:diva-48406DOI: 10.1097/01.BRS.0000102681.61791.12ISI: 000220041000012PubMedID: 15094539OAI: oai:DiVA.org:liu-48406DiVA: diva2:269302