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Circumferential fusion is dominant over posterolateral fusion in a long-term perspective: cost-utility evaluation of a randomized controlled trial in severe, chronic low back pain.
Spine (Phila Pa 1976). 2007 Oct 15; 32(22):2405-14.S

Abstract

STUDY DESIGN

Cost-utility evaluation of a randomized, controlled trial with a 4- to 8-year follow-up.

OBJECTIVE

To investigate the incremental cost per quality-adjusted-life-year (QALY) when comparing circumferential fusion to posterolateral fusion in a long-term, societal perspective.

SUMMARY OF BACKGROUND DATA

The cost-effectiveness of circumferential fusion in a long-term perspective is uncertain but nonetheless highly relevant as the ISSLS prize winner 2006 in clinical studies reported the effect of circumferential fusion superior to the effect of posterolateral fusion. A recent trial found no significant difference between posterolateral and circumferential fusion reporting cost-effectiveness from a 2-year viewpoint.

METHODS

A total of 146 patients were randomized to posterolateral or circumferential fusion and followed 4 to 8 years after surgery. The mean age of the cohort was 46 years (range, 20-65 years); 61% were females, 49% were smokers, 30% had primary diagnosis of isthmic spondylolisthesis, 35% had disc degeneration and no previous surgery, and 35% had disc degeneration and previous surgery. Eighty-two percent of patients have had symptoms for more than 2 years and 50% were out of the labor market due to sickness. The EQ-5D instrument was applied for the measurement of health-related quality of life and costs (2004 U.S. dollars) were measured in a full-scale societal perspective. Productivity costs were valued by the Friction Cost method, and both costs and effects were discounted. Arithmetic means and 95% bias-corrected, bootstrapped confidence intervals were reported. Nonparametric statistics were used for tests of statistical significance. Comprehensive sensitivity analysis was conducted and reported using cost-effectiveness acceptability curves.

RESULTS

The circumferential group demonstrated clinical superiority over the posterolateral fusion group in functional outcome (P < 0.01), fusion rate (P < 0.04), and number of reoperations (P < 0.01) among others. Cost-utility analysis demonstrated circumferential fusion dominant over posterolateral fusion, that is, for each QALY gained performing circumferential fusion, the incremental saving was estimated at U.S. $49,306 (95% confidence interval, $27,183-$2,735,712). Results proved to be strong to various sensitivity analyses; only a differentiated underestimation of patients' need for postoperative household help against the circumferential approach could alter the dominance; however, still the probability of cost-effectiveness was >0.85 given a threshold for willingness to pay of U.S. $50,000 per QALY.

CONCLUSION

Circumferential fusion is dominant over instrumented posterolateral fusion, that is, both being significantly cheaper and significantly better in a long-term, societal perspective.

Authors+Show Affiliations

Orthopaedic Research Laboratory, University Hospital of Aarhus, Aarhus, Denmark. rikke.sogaard@ki.au.dkNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18090078

Citation

Soegaard, Rikke, et al. "Circumferential Fusion Is Dominant Over Posterolateral Fusion in a Long-term Perspective: Cost-utility Evaluation of a Randomized Controlled Trial in Severe, Chronic Low Back Pain." Spine, vol. 32, no. 22, 2007, pp. 2405-14.
Soegaard R, Bünger CE, Christiansen T, et al. Circumferential fusion is dominant over posterolateral fusion in a long-term perspective: cost-utility evaluation of a randomized controlled trial in severe, chronic low back pain. Spine (Phila Pa 1976). 2007;32(22):2405-14.
Soegaard, R., Bünger, C. E., Christiansen, T., Høy, K., Eiskjaer, S. P., & Christensen, F. B. (2007). Circumferential fusion is dominant over posterolateral fusion in a long-term perspective: cost-utility evaluation of a randomized controlled trial in severe, chronic low back pain. Spine, 32(22), 2405-14.
Soegaard R, et al. Circumferential Fusion Is Dominant Over Posterolateral Fusion in a Long-term Perspective: Cost-utility Evaluation of a Randomized Controlled Trial in Severe, Chronic Low Back Pain. Spine (Phila Pa 1976). 2007 Oct 15;32(22):2405-14. PubMed PMID: 18090078.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Circumferential fusion is dominant over posterolateral fusion in a long-term perspective: cost-utility evaluation of a randomized controlled trial in severe, chronic low back pain. AU - Soegaard,Rikke, AU - Bünger,Cody E, AU - Christiansen,Terkel, AU - Høy,Kristian, AU - Eiskjaer,Søren P, AU - Christensen,Finn B, PY - 2007/12/20/pubmed PY - 2008/1/17/medline PY - 2007/12/20/entrez SP - 2405 EP - 14 JF - Spine JO - Spine (Phila Pa 1976) VL - 32 IS - 22 N2 - STUDY DESIGN: Cost-utility evaluation of a randomized, controlled trial with a 4- to 8-year follow-up. OBJECTIVE: To investigate the incremental cost per quality-adjusted-life-year (QALY) when comparing circumferential fusion to posterolateral fusion in a long-term, societal perspective. SUMMARY OF BACKGROUND DATA: The cost-effectiveness of circumferential fusion in a long-term perspective is uncertain but nonetheless highly relevant as the ISSLS prize winner 2006 in clinical studies reported the effect of circumferential fusion superior to the effect of posterolateral fusion. A recent trial found no significant difference between posterolateral and circumferential fusion reporting cost-effectiveness from a 2-year viewpoint. METHODS: A total of 146 patients were randomized to posterolateral or circumferential fusion and followed 4 to 8 years after surgery. The mean age of the cohort was 46 years (range, 20-65 years); 61% were females, 49% were smokers, 30% had primary diagnosis of isthmic spondylolisthesis, 35% had disc degeneration and no previous surgery, and 35% had disc degeneration and previous surgery. Eighty-two percent of patients have had symptoms for more than 2 years and 50% were out of the labor market due to sickness. The EQ-5D instrument was applied for the measurement of health-related quality of life and costs (2004 U.S. dollars) were measured in a full-scale societal perspective. Productivity costs were valued by the Friction Cost method, and both costs and effects were discounted. Arithmetic means and 95% bias-corrected, bootstrapped confidence intervals were reported. Nonparametric statistics were used for tests of statistical significance. Comprehensive sensitivity analysis was conducted and reported using cost-effectiveness acceptability curves. RESULTS: The circumferential group demonstrated clinical superiority over the posterolateral fusion group in functional outcome (P < 0.01), fusion rate (P < 0.04), and number of reoperations (P < 0.01) among others. Cost-utility analysis demonstrated circumferential fusion dominant over posterolateral fusion, that is, for each QALY gained performing circumferential fusion, the incremental saving was estimated at U.S. $49,306 (95% confidence interval, $27,183-$2,735,712). Results proved to be strong to various sensitivity analyses; only a differentiated underestimation of patients' need for postoperative household help against the circumferential approach could alter the dominance; however, still the probability of cost-effectiveness was >0.85 given a threshold for willingness to pay of U.S. $50,000 per QALY. CONCLUSION: Circumferential fusion is dominant over instrumented posterolateral fusion, that is, both being significantly cheaper and significantly better in a long-term, societal perspective. SN - 1528-1159 UR - https://www.unboundmedicine.com/medline/citation/18090078/Circumferential_fusion_is_dominant_over_posterolateral_fusion_in_a_long_term_perspective:_cost_utility_evaluation_of_a_randomized_controlled_trial_in_severe_chronic_low_back_pain_ L2 - https://doi.org/10.1097/BRS.0b013e3181573b2d DB - PRIME DP - Unbound Medicine ER -