Cost-effectiveness of postoperative rehabilitation after surgery for lumbar disc herniation: an analysis based on a randomized controlled trial

Restricted access

OBJECTIVE

The aim of this study was to examine whether routine referral to municipal postoperative rehabilitation is cost-effective in comparison to no referral after surgery for lumbar disc herniation (LDH).

METHODS

One hundred forty-six patients scheduled for primary discectomy due to LDH were included. This secondary analysis, based on data from a previous randomized controlled trial, compared costs and quality-adjusted life years (QALYs) between two groups of patients recovering from LDH surgery: one group of patients received a referral for municipal physical rehabilitation (REHAB) and the other group was sent home without a referral to any postoperative rehabilitation (HOME). Primary outcomes were QALYs calculated from the EQ-5D utility score, societal costs, and incremental cost-effectiveness ratios (ICERs). The main cost-effectiveness analysis used intention-to-treat data, whereas sensitivity analyses included as-treated data. Questionnaires were collected after 1, 3, 6, 12, and 24 months postoperatively.

RESULTS

The main cost-effectiveness analysis showed a small, insignificant incremental QALY of 0.021 and an incremental cost of €211.8 for the REHAB group compared to the HOME group, resulting in an ICER of €10,085. In the as-treated sensitivity analysis, the REHAB group had poorer outcomes and higher costs compared to the HOME group.

CONCLUSIONS

Routine referral to municipal physical rehabilitation in patients recovering from LDH surgery was not cost-effective compared to no referral.

Clinical trial registration no.: NCT03505918 (clinicaltrials.gov)

ABBREVIATIONS ICER = incremental cost-effectiveness ratio; LDH = lumbar disc herniation; MCID = minimum clinically important difference; ODI = Oswestry Disability Index; QALY = quality-adjusted life year; RTW = return to work.
Article Information

Contributor Notes

Correspondence Rune Tendal Paulsen: Spine Centre of Southern Denmark, Lillebaelt Hospital, Middelfart, Denmark. rune.tendal.paulsen@rsyd.dk.INCLUDE WHEN CITING Published online January 17, 2020; DOI: 10.3171/2019.11.SPINE191003.Disclosures Dr. Carreon reports that researchers and PhD students affiliated with the Spine Surgery and Research department at the Spine Center of Southern Denmark have received financial support from Sygehus Lillebælt Forskningsråd, Sygehus Lillebælt Udviklingsråd, SDU faculty scholarship, Gangstedsfonden, Gigtforeningen, Region Syddanmarks ph.d. pulje, Region Syddanmarks forskningspulje, Region Sjælland og Region Syddanmarks fælles forskningspulje, Det Frie Forskningsråd, A.P. Møller Fonden for Lægevidenskabens Fremme, Inger Goldmanns Fond, IMK Almene Fond, Aase og Ejnar Danielsens Fond, Overlæge Jørgen Werner Schous og hustru, Else-Marie Schou, født Wonge’s fond, Cerapedics, Fonden til fremme af kiropraktisk forskning og postgraduat uddannelse, Eli Lilly, Kroghs Legat, Ortotech, Guildal Fondet, and Janssen-Cilag A/S.Dr. Carreon is an employee of Norton Healthcare. She is on the editorial advisory board of Spine Deformity, The Spine Journal, and Spine. She is a member of the IRB at the University of Louisville, and she is on the research committee at SRS.
Headings
References
  • 1

    Andersen MNielsen MBech-Azeddine RHelmig og Søren Eiskjær P: DaneSpine Annual Report 2017 (http://www.drksdanespine.dk/wm420129) [Accessed November 20 2019]

    • Search Google Scholar
    • Export Citation
  • 2

    Copay AGGlassman SDSubach BRBerven SSchuler TCCarreon LY: Minimum clinically important difference in lumbar spine surgery patients: a choice of methods using the Oswestry Disability Index, Medical Outcomes Study questionnaire Short Form 36, and pain scales. Spine J 8:9689742008

    • Search Google Scholar
    • Export Citation
  • 3

    Fairbank JCTPynsent PB: The Oswestry Disability Index. Spine (Phila Pa 1976) 25:294029522000

  • 4

    Gadjradj PSArts MPvan Tulder MWRietdijk WJRPeul WCHarhangi BS: Management of symptomatic lumbar disk herniation: an international perspective. Spine (Phila Pa 1976) 42:182618342017

    • Search Google Scholar
    • Export Citation
  • 5

    Højmark KStøttrup CCarreon LAndersen MO: Patient-reported outcome measures unbiased by loss of follow-up. Single-center study based on DaneSpine, the Danish spine surgery registry. Eur Spine J 25:2822862016

    • Search Google Scholar
    • Export Citation
  • 6

    Johnsen LGHellum CNygaard ØPStorheim KBrox JIRossvoll I: Comparison of the SF6D, the EQ5D, and the Oswestry Disability Index in patients with chronic low back pain and degenerative disc disease. BMC Musculoskelet Disord 14:1482013

    • Search Google Scholar
    • Export Citation
  • 7

    Laegeforeningen: Honorarer og takster. Praktiserende Lægers Organisation (https://www.laeger.dk/PLO-honorarer-og-takster) [Accessed November 20 2019]

    • Export Citation
  • 8

    Luijsterburg PAJVerhagen APOstelo RWJGvan Os TAGPeul WCKoes BW: Effectiveness of conservative treatments for the lumbosacral radicular syndrome: a systematic review. Eur Spine J 16:8818992007

    • Search Google Scholar
    • Export Citation
  • 9

    McCabe CClaxton KCulyer AJ: The NICE cost-effectiveness threshold: what it is and what that means. Pharmacoeconomics 26:7337442008

    • Search Google Scholar
    • Export Citation
  • 10

    Moher DHopewell SSchulz KFMontori VGøtzsche PCDevereaux PJ: CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. Int J Surg 10:28552012

    • Search Google Scholar
    • Export Citation
  • 11

    Morris SMorris TPMcGregor AHDoré CJJamrozik K: Function after spinal treatment, exercise, and rehabilitation: cost-effectiveness analysis based on a randomized controlled trial. Spine (Phila Pa 1976) 36:180718142011

    • Search Google Scholar
    • Export Citation
  • 12

    Oosterhuis TCosta LOPMaher CGde Vet HCWvan Tulder MWOstelo RWJG: Rehabilitation after lumbar disc surgery. Cochrane Database Syst Rev 3:CD0030072014

    • Search Google Scholar
    • Export Citation
  • 13

    Oosterhuis TOstelo RWvan Dongen JMPeul WCde Boer MRBosmans JE: Early rehabilitation after lumbar disc surgery is not effective or cost-effective compared to no referral: a randomised trial and economic evaluation. J Physiother 63:1441532017

    • Search Google Scholar
    • Export Citation
  • 14

    Paulsen RTBergholdt ECarreon LRousing RHansen KHAndersen M: No differences in post-operative rehabilitation across municipalities in patients with lumbar disc herniation. Dan Med J 62:A51042015

    • Search Google Scholar
    • Export Citation
  • 15

    Paulsen RTCarreon LYAndersen : Patient reported outcomes after surgery for lumbar disk herniation, a randomized controlled trial comparing the effects of referral to municipal physical rehabilitation versus no referral. Spine (Phila Pa 1976) 45:392020

    • Search Google Scholar
    • Export Citation
  • 16

    Paulsen RTRasmussen JCarreon LYAndersen : Return to work after surgery for lumbar disc herniation, secondary analyses from a randomized controlled trial comparing supervised rehabilitation versus home exercises. Spine J 20:41472020

    • Search Google Scholar
    • Export Citation
  • 17

    Sørensen JDavidsen MGudex CPedersen KMBrønnum-Hansen H: Danish EQ-5D population norms. Scand J Public Health 37:4674742009

    • Search Google Scholar
    • Export Citation
  • 18

    Stafford MAPeng PHill DA: Sciatica: a review of history, epidemiology, pathogenesis, and the role of epidural steroid injection in management. Br J Anaesth 99:4614732007

    • Search Google Scholar
    • Export Citation
TrendMD
Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 594 594 530
Full Text Views 57 57 53
PDF Downloads 37 37 37
EPUB Downloads 0 0 0
PubMed
Google Scholar