Cost–utility analysis of routine neurosurgical spinal surgery

Pirjo Räsänen M.Sc.1, Juha Öhman M.D., Ph.D.1, Harri Sintonen Ph.D.1, Olli-Pekka Ryynänen M.D., Ph.D.1, Anna-Maija Koivisto M.Sc.1, Marja Blom Ph.D.1, and Risto P. Roine M.D., Ph.D.1
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  • 1 Group Administration, Helsinki and Uusimaa Hospital Group, Helsinki; Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, and University of Tampere; Department of Public, Health University of Helsinki and Finnish Office for Health TechnologyAssessment; Department of Health Policy and Management, University of Kuopio; School of Public Health, University of Tampere; and Academy of Finland, and Helsinki University Central Hospital, Jorvi Hospital, Espoo, Finland
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Object

Cost–utility analysis is currently the preferred method with which to compare the cost-effectiveness of various interventions. The authors conducted a study to establish the cost–utility results of routine neurosurgery-based spinal interventions by examining patient-derived values.

Methods

Two hundred seventy patients undergoing surgery for cervical or lumbar radicular pain filled in the 15-dimensional health-related quality of life (HRQOL) questionnaire before and 3 months after surgery. Quality-adjusted life years (QALYs) were calculated using the utility data and the expected remaining life years of the patients. The mean HRQOL score (scale, 0–1) increased after cervical surgery (169 patients, mean age 52 years, 40% women) from 0.81 ± 0.11 preoperatively, to 0.85 ± 0.11 at 3 months, and after lumbar surgery (101 patients, mean age 54 years, 59% women) from 0.79 ± 0.10 preoperatively, to 0.85 ± 0.12 at 3 months (p < 0.001). Of the 15 dimensions of health, improvement in the following was documented in both groups: sleeping, usual activities, discomfort and symptoms, depression, distress, vitality, and sexual activity (p < 0.05). The cost per QALY gained was €2774 and 1738 for cervical and lumbar operations, respectively. In cases in which surgery was delayed the cost per QALY was doubled.

Conclusions

Spinal surgery led to a statistically significant and clinically important improvement in HRQOL. The cost per QALY gained was reasonable, less than half of that observed, for example, for hip replacement surgery or angioplasty treatment of coronary artery disease; however, a prolonged delay in surgical intervention led to an approximate doubling of the cost per QALY gained by the treatment.

Abbreviations used in this paper:

CI = confidence interval; HRQOL = health-related quality of life; QALY = quality-adjusted life year; SD = standard deviation; 15D = 15-dimensional questionnaire.

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