Cost-effectiveness of lumbar artificial intervertebral disc replacement: driven by the choice of comparator
Background Lower back pain is a common and costly condition in Australia. This paper aims to conduct an economic evaluation of lumbar artificial intervertebral disc replacement (AIDR) compared with lumbar fusion for the treatment of patients suffering from significant axial back pain and/or radicula...
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Published in | ANZ journal of surgery Vol. 83; no. 9; pp. 669 - 675 |
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Main Authors | , , |
Format | Journal Article |
Language | English |
Published |
Australia
Blackwell Publishing Ltd
01.09.2013
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Abstract | Background
Lower back pain is a common and costly condition in Australia. This paper aims to conduct an economic evaluation of lumbar artificial intervertebral disc replacement (AIDR) compared with lumbar fusion for the treatment of patients suffering from significant axial back pain and/or radicular (nerve root) pain, secondary to disc degeneration or prolapse, who have failed conservative treatment.
Methods
A cost‐effectiveness approach was used to compare costs and benefits of AIDR to five fusion approaches. Resource use was based on Medicare Benefits Schedule claims data and expert opinion. Effectiveness and re‐operation rates were based on published randomized controlled trials. The key clinical outcomes considered were narcotic medication discontinuation, achievement of overall clinical success, achievement of Oswestry Disability Index success and quality‐adjusted life‐years gained.
Results
AIDR was estimated to be cost‐saving compared with fusion overall ($1600/patient); however, anterior lumbar interbody fusion and posterolateral fusion were less costly by $2155 and $807, respectively. The incremental cost‐effectiveness depends on the outcome considered and the comparator.
Conclusions
AIDR is potentially a cost‐saving treatment for lumbar disc degeneration, although longer‐term follow‐up data are required to substantiate this claim. The incremental cost‐effectiveness depends on the outcome considered and the comparator, and further research is required before any firm conclusions can be drawn. |
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AbstractList | Lower back pain is a common and costly condition in Australia. This paper aims to conduct an economic evaluation of lumbar artificial intervertebral disc replacement (AIDR) compared with lumbar fusion for the treatment of patients suffering from significant axial back pain and/or radicular (nerve root) pain, secondary to disc degeneration or prolapse, who have failed conservative treatment.
A cost-effectiveness approach was used to compare costs and benefits of AIDR to five fusion approaches. Resource use was based on Medicare Benefits Schedule claims data and expert opinion. Effectiveness and re-operation rates were based on published randomized controlled trials. The key clinical outcomes considered were narcotic medication discontinuation, achievement of overall clinical success, achievement of Oswestry Disability Index success and quality-adjusted life-years gained.
AIDR was estimated to be cost-saving compared with fusion overall ($1600/patient); however, anterior lumbar interbody fusion and posterolateral fusion were less costly by $2155 and $807, respectively. The incremental cost-effectiveness depends on the outcome considered and the comparator.
AIDR is potentially a cost-saving treatment for lumbar disc degeneration, although longer-term follow-up data are required to substantiate this claim. The incremental cost-effectiveness depends on the outcome considered and the comparator, and further research is required before any firm conclusions can be drawn. BACKGROUNDLower back pain is a common and costly condition in Australia. This paper aims to conduct an economic evaluation of lumbar artificial intervertebral disc replacement (AIDR) compared with lumbar fusion for the treatment of patients suffering from significant axial back pain and/or radicular (nerve root) pain, secondary to disc degeneration or prolapse, who have failed conservative treatment.METHODSA cost-effectiveness approach was used to compare costs and benefits of AIDR to five fusion approaches. Resource use was based on Medicare Benefits Schedule claims data and expert opinion. Effectiveness and re-operation rates were based on published randomized controlled trials. The key clinical outcomes considered were narcotic medication discontinuation, achievement of overall clinical success, achievement of Oswestry Disability Index success and quality-adjusted life-years gained.RESULTSAIDR was estimated to be cost-saving compared with fusion overall ($1600/patient); however, anterior lumbar interbody fusion and posterolateral fusion were less costly by $2155 and $807, respectively. The incremental cost-effectiveness depends on the outcome considered and the comparator.CONCLUSIONSAIDR is potentially a cost-saving treatment for lumbar disc degeneration, although longer-term follow-up data are required to substantiate this claim. The incremental cost-effectiveness depends on the outcome considered and the comparator, and further research is required before any firm conclusions can be drawn. Background Lower back pain is a common and costly condition in Australia. This paper aims to conduct an economic evaluation of lumbar artificial intervertebral disc replacement (AIDR) compared with lumbar fusion for the treatment of patients suffering from significant axial back pain and/or radicular (nerve root) pain, secondary to disc degeneration or prolapse, who have failed conservative treatment. Methods A cost‐effectiveness approach was used to compare costs and benefits of AIDR to five fusion approaches. Resource use was based on Medicare Benefits Schedule claims data and expert opinion. Effectiveness and re‐operation rates were based on published randomized controlled trials. The key clinical outcomes considered were narcotic medication discontinuation, achievement of overall clinical success, achievement of Oswestry Disability Index success and quality‐adjusted life‐years gained. Results AIDR was estimated to be cost‐saving compared with fusion overall ($1600/patient); however, anterior lumbar interbody fusion and posterolateral fusion were less costly by $2155 and $807, respectively. The incremental cost‐effectiveness depends on the outcome considered and the comparator. Conclusions AIDR is potentially a cost‐saving treatment for lumbar disc degeneration, although longer‐term follow‐up data are required to substantiate this claim. The incremental cost‐effectiveness depends on the outcome considered and the comparator, and further research is required before any firm conclusions can be drawn. Background: Lower back pain is a common and costly condition in Australia. This paper aims to conduct an economic evaluation of lumbar artificial intervertebral disc replacement (AIDR) compared with lumbar fusion for the treatment of patients suffering from significant axial back pain and/or radicular (nerve root) pain, secondary to disc degeneration or prolapse, who have failed conservative treatment. Methods: A cost-effectiveness approach was used to compare costs and benefits of AIDR to five fusion approaches. Resource use was based on Medicare Benefits Schedule claims data and expert opinion. Effectiveness and re-operation rates were based on published randomized controlled trials. The key clinical outcomes considered were narcotic medication discontinuation, achievement of overall clinical success, achievement of Oswestry Disability Index success and quality-adjusted life-years gained. Results: AIDR was estimated to be cost-saving compared with fusion overall ($1600/patient); however, anterior lumbar interbody fusion and posterolateral fusion were less costly by $2155 and $807, respectively. The incremental cost-effectiveness depends on the outcome considered and the comparator. Conclusions: AIDR is potentially a cost-saving treatment for lumbar disc degeneration, although longer-term follow-up data are required to substantiate this claim. The incremental cost-effectiveness depends on the outcome considered and the comparator, and further research is required before any firm conclusions can be drawn.[PUBLICATION ABSTRACT] |
Author | Parkinson, Bonny Thavaneswaran, Prema Goodall, Stephen |
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References_xml | – year: 2011 – volume: 6 start-page: 1 year: 2006 end-page: 98 article-title: Artificial discs for lumbar and cervical degenerative disc disease‐update: an evidence‐based analysis publication-title: Ont. Health Technol. Assess. Ser. – volume: 31 start-page: 1217 year: 2006 end-page: 1226 article-title: Revisability of the CHARITE artificial disc replacement: analysis of 688 patients enrolled in the U.S. IDE study of the CHARITE Artificial Disc publication-title: Spine – year: 2009 – volume: 26 start-page: 2521 year: 2001 end-page: 2532 article-title: Volvo Award Winner in Clinical Studies: lumbar fusion versus nonsurgical treatment for chronic low back pain: a multicenter randomized controlled trial from the Swedish Lumbar Spine Study Group publication-title: Spine – volume: 7 start-page: 558 year: 2007 end-page: 562 article-title: An economic model of one‐level lumbar arthroplasty versus fusion publication-title: Spine J. – volume: 15 start-page: S439 issue: Suppl. 3 year: 2006 end-page: 447 article-title: Total disc replacement in the lumbar spine: a systematic review of the literature publication-title: Eur. Spine J. – volume: 8 start-page: 13 year: 2008 end-page: 16 article-title: Patient selection for lumbar arthroplasty and arthrodesis: the effect of revision surgery in a controlled, multicenter, randomized study publication-title: J. Neurosurg. Spine – year: 2008 – volume: 30 start-page: 1565 year: 2005 end-page: 1575 article-title: A prospective, randomized, multicenter Food and Drug Administration investigational device exemptions study of lumbar total disc replacement with the CHARITE artificial disc versus lumbar fusion: part I: evaluation of clinical outcomes publication-title: Spine – volume: 21 start-page: 473 year: 2008 end-page: 476 article-title: Lumbar spinal fusion versus anterior lumbar disc replacement: the financial implications publication-title: J. Spinal Disord. Tech. – volume: 32 start-page: 2905 year: 2007 end-page: 2909 article-title: Comparative charge analysis of one‐ and two‐level lumbar total disc arthroplasty versus circumferential lumbar fusion publication-title: Spine – volume: 33 start-page: 1701 year: 2008 end-page: 1707 article-title: Lumbar adjacent segment degeneration and disease after arthrodesis and total disc arthroplasty publication-title: Spine – year: 2007–2008 – volume: 86 start-page: 1497 year: 2004 end-page: 1503 article-title: Adjacent segment degeneration in the lumbar spine publication-title: J. Bone Joint Surg. Am. – volume: 20 start-page: 1001 year: 2011 end-page: 1011 article-title: Cost effectiveness of disc prosthesis versus lumbar fusion in patients with chronic low back pain: randomized controlled trial with 2‐year follow‐up publication-title: Eur. Spine J. – volume: 32 start-page: 1155 year: 2007 end-page: 1162 article-title: Results of the prospective, randomized, multicenter Food and Drug Administration investigational device exemption study of the ProDisc‐L total disc replacement versus circumferential fusion for the treatment of 1‐level degenerative disc disease publication-title: Spine – volume: 18 start-page: 1512 year: 2009 end-page: 1519 article-title: Total disc replacement compared to lumbar fusion: a randomised controlled trial with 2‐year follow‐up publication-title: Eur. Spine J. – volume: 16 start-page: 199 year: 1990 end-page: 208 article-title: EuroQol‐a new facility for the measurement of health‐related quality of life publication-title: Health Policy – volume: 33 start-page: 123 year: 2008 end-page: 131 article-title: Prospective, randomized trial of metal‐on‐metal artificial lumbar disc replacement: initial results for treatment of discogenic pain publication-title: Spine – year: 2010 |
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Snippet | Background
Lower back pain is a common and costly condition in Australia. This paper aims to conduct an economic evaluation of lumbar artificial intervertebral... Lower back pain is a common and costly condition in Australia. This paper aims to conduct an economic evaluation of lumbar artificial intervertebral disc... Background: Lower back pain is a common and costly condition in Australia. This paper aims to conduct an economic evaluation of lumbar artificial... BACKGROUNDLower back pain is a common and costly condition in Australia. This paper aims to conduct an economic evaluation of lumbar artificial intervertebral... |
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SubjectTerms | Australia Back pain Back surgery Cost-Benefit Analysis cost-effectiveness analysis Costs economics Evaluation Health Care Costs Health care expenditures Health insurance Humans Intervertebral Disc Displacement - complications Intervertebral Disc Displacement - economics Intervertebral Disc Displacement - surgery Low back pain Low Back Pain - economics Low Back Pain - etiology lumbar artificial intervertebral disc replacement Markov Chains Medicare Benefits Schedule Models, Economic Models, Statistical Oswestry Disability Index Quality-Adjusted Life Years Radiculopathy - economics Radiculopathy - etiology Reoperation - economics Spinal Fusion - economics Surgery Surgical techniques Total Disc Replacement - economics Treatment Outcome |
Title | Cost-effectiveness of lumbar artificial intervertebral disc replacement: driven by the choice of comparator |
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