Cost-effectiveness of transforaminal lumbar interbody fusion for Grade I degenerative spondylolisthesis

Clinical article

Restricted access

Object

Transforaminal lumbar interbody fusion (TLIF) for spondylolisthesis-associated back and leg pain is associated with improvement in pain, disability, and quality of life. However, given the rising health care costs associated with spinal fusion procedures and varying results of recent cost-utility studies, the cost-effectiveness of TLIF remains unclear. The authors set out to assess the comprehensive costs of TLIF at their institution and to determine its cost-effectiveness in the treatment of degenerative spondylolisthesis.

Methods

Forty-five patients undergoing TLIF for Grade I degenerative spondylolisthesis–associated back and leg pain after 6–12 months of conservative therapy were included. The authors assessed the 2-year back pain visual analog scale (VAS) score, leg pain VAS score, Oswestry Disability Index, and total back-related medical resource utilization, missed work, and health-state values (quality-adjusted life years [QALYs], calculated from EQ-5D with US valuation). Two-year resource use was multiplied by unit costs based on Medicare national allowable payment amounts (direct cost), and patient and caregiver workday losses were multiplied by the self-reported gross-of-tax wage rate (indirect cost). The mean total 2-year cost per QALY gained after TLIF was assessed.

Results

Compared with preoperative health states reported after at least 6 months of medical management, a significant improvement in back pain VAS score, leg pain VAS score, and Oswestry Disability Index was observed 2 years after TLIF, with a mean 2-year gain of 0.86 QALYs. The mean ± SD total 2-year cost of TLIF was $36,836 ± $11,800 (surgery cost, $21,311 ± $2800; outpatient resource utilization cost, $3940 ± $2720; indirect cost, $11,584 ± $11,363). Transforaminal lumbar interbody fusion was associated with a mean 2-year cost per QALY gained of $42,854.

Conclusions

Transforaminal lumbar interbody fusion improved pain, disability, and quality of life in patients with degenerative spondylolisthesis–associated back and leg pain. The total cost per QALY gained for TLIF was $42,854 when evaluated 2 years after surgery with Medicare fees, suggesting that TLIF is a cost-effective treatment of lumbar spondylolisthesis.

Abbreviations used in this paper: EQ-5D = EuroQol 5 Dimensions; ODI = Oswestry Disability Index; QALY = quality-adjusted life year; SPORT = Spine Patient Outcomes Research Trial; TLIF = transforaminal lumbar interbody fusion; VAS = visual analog scale.

Article Information

Address correspondence to: Matthew J. McGirt, M.D., 4347 Village at Vanderbilt, Nashville, Tennessee 37232-8618. email: matthew.mcgirt@vanderbilt.com.

Please include this information when citing this paper: published online May 6, 2011; DOI: 10.3171/2011.3.SPINE10562.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Graph. Compared with the preoperative state (postmedical treatment [post med Rx]), a significant improvement in leg pain (VASLP), back pain (VAS-BP), and low-back specific disability (ODI) was observed 2 years after TLIF.

References

  • 1

    Amundsen TWeber HNordal HJMagnaes BAbdelnoor MLilleâs F: Lumbar spinal stenosis: conservative or surgical management?: A prospective 10-year study. Spine (Phila Pa 1976) 25:142414362000

    • Search Google Scholar
    • Export Citation
  • 2

    Badia XDiaz-Prieto AGorriz MTHerdman MTorrado HFarrero E: Using the EuroQol-5D to measure changes in quality of life 12 months after discharge from an intensive care unit. Intensive Care Med 27:190119072001

    • Search Google Scholar
    • Export Citation
  • 3

    Chang RWPellisier JMHazen GB: A cost-effectiveness analysis of total hip arthroplasty for osteoarthritis of the hip. JAMA 275:8588651996

    • Search Google Scholar
    • Export Citation
  • 4

    Copay AGSubach BRGlassman SDPolly DW JrSchuler TC: Understanding the minimum clinically important difference: a review of concepts and methods. Spine J 7:5415462007

    • Search Google Scholar
    • Export Citation
  • 5

    Deyo RANachemson AMirza SK: Spinal-fusion surgery—the case for restraint. N Engl J Med 350:7227262004

  • 6

    Drewett RFMinns RJSibly TF: Measuring outcome of total knee replacement using quality of life indices. Ann R Coll Surg Engl 74:2862901992

    • Search Google Scholar
    • Export Citation
  • 7

    Fairbank JCCouper JDavies JBO'Brien JP: The Oswestry low back pain disability questionnaire. Physiotherapy 66:2712731980

  • 8

    Fritzell PHägg OJonsson DNordwall A: 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. Spine (Phila Pa 1976) 29:4214342004

    • Search Google Scholar
    • Export Citation
  • 9

    Glassman SDPolly DWDimar JRCarreon LY: The cost effectiveness of single-level instrumented posterolateral lumbar fusion at five years after surgery. Spine (Phila Pa 1976) [epub ahead of print]2010

    • Search Google Scholar
    • Export Citation
  • 10

    Hodgson TAMeiners MR: Cost-of-illness methodology: a guide to current practices and procedures. Milbank Mem Fund Q Health Soc 60:4294621982

    • Search Google Scholar
    • Export Citation
  • 11

    Iguchi TKurihara ANakayama JSato KKurosaka MYamasaki K: Minimum 10-year outcome of decompressive laminectomy for degenerative lumbar spinal stenosis. Spine (Phila Pa 1976) 25:175417592000

    • Search Google Scholar
    • Export Citation
  • 12

    Jansson KANémeth GGranath FJönsson BBlomqvist P: Health-related quality of life (EQ-5D) before and one year after surgery for lumbar spinal stenosis. J Bone Joint Surg Br 91:2102162009

    • Search Google Scholar
    • Export Citation
  • 13

    Kuntz KMSnider RKWeinstein JNPope MHKatz JN: Cost-effectiveness of fusion with and without instrumentation for patients with degenerative spondylolisthesis and spinal stenosis. Spine (Phila Pa 1976) 25:113211392000

    • Search Google Scholar
    • Export Citation
  • 14

    Thomé CZevgaridis DLeheta OBäzner HPöckler-Schöniger CWöhrle J: Outcome after less-invasive decompression of lumbar spinal stenosis: a randomized comparison of unilateral laminotomy, bilateral laminotomy, and laminectomy. J Neurosurg Spine 3:1291412005

    • Search Google Scholar
    • Export Citation
  • 15

    Tosteson ANLurie JDTosteson TDSkinner JSHerkowitz HAlbert T: Surgical treatment of spinal stenosis with and without degenerative spondylolisthesis: cost-effectiveness after 2 years. Ann Intern Med 149:8458532008

    • Search Google Scholar
    • Export Citation
  • 16

    Tosteson ANSkinner JSTosteson TDLurie JDAndersson GBBerven S: The cost effectiveness of surgical versus nonoperative treatment for lumbar disc herniation over two years: evidence from the Spine Patient Outcomes Research Trial (SPORT). Spine (Phila Pa 1976) 33:210821152008

    • Search Google Scholar
    • Export Citation
  • 17

    Wang MYCummock MDYu YTrivedi RA: An analysis of the differences in the acute hospitalization charges following minimally invasive versus open posterior lumbar interbody fusion. Clinical article. J Neurosurg Spine 12:6946992010

    • Search Google Scholar
    • Export Citation
  • 18

    Weiner DKKim YSBonino PWang T: Low back pain in older adults: are we utilizing healthcare resources wisely?. Pain Med 7:1431502006

    • Search Google Scholar
    • Export Citation
  • 19

    Weinstein JNLurie JDOlson PRBronner KKFisher ES: United States' trends and regional variations in lumbar spine surgery: 1992–2003. Spine (Phila Pa 1976) 31:270727142006

    • Search Google Scholar
    • Export Citation
  • 20

    Weinstein JNLurie JDTosteson TDHanscom BTosteson ANBlood EA: Surgical versus nonsurgical treatment for lumbar degenerative spondylolisthesis. N Engl J Med 356:225722702007

    • Search Google Scholar
    • Export Citation
  • 21

    Wong JBSingh GKavanaugh A: Estimating the cost-effectiveness of 54 weeks of infliximab for rheumatoid arthritis. Am J Med 113:4004082002

    • Search Google Scholar
    • Export Citation

TrendMD

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 199 199 11
Full Text Views 100 100 4
PDF Downloads 123 123 3
EPUB Downloads 0 0 0

PubMed

Google Scholar