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

Abstract

In Brief Study Design. A cost-effectiveness study was performed from the societal and health care perspectives. Objective. To evaluate the costs-effectiveness of lumbar fusion for chronic low back pain (CLBP) during a 2-year follow-up. Summary of Background Data. A full economic evaluation comparing costs related to treatment effects in patients with CLBP is lacking. Patients and Methods. A total of 284 of 294 patients with CLBP for at least 2 years were randomized to either lumbar fusion or a nonsurgical control group. Costs for the health care sector (direct costs), and costs associated with production losses (indirect costs) were calculated. Societal total costs were identified as the sum of direct and indirect costs. Treatment effects were measured using patient global assessment of improvement, back pain (VAS), functional disability (Owestry), and return to work. Results. The societal total cost per patient (standard deviations) in the surgical group was significantly higher than in the nonsurgical group: Swedish kroner (SEK) 704,000 (254,000) vs. SEK 636,000 (208,000). The cost per patient for the health care sector was significantly higher for the surgical group, SEK 123,000 (60,100) vs. 65,200 (38,400) for the control group. All treatment effects were significantly better after surgery. The incremental cost-effectiveness ratio (ICER), illustrating the extra cost per extra effect unit gained by using fusion instead of nonsurgical treatment, were for improvement: SEK 2,600 (600–5,900), for back pain: SEK 5,200 (1,100–11,500), for Oswestry: SEK 11,300 (1,200–48,000), and for return to work: SEK 4,100 (100–21,400). Conclusion. For both the society and the health care sectors, the 2-year costs for lumbar fusion was significantly higher compared with nonsurgical treatment but all treatment effects were significantly in favor of surgery. The probability of lumbar fusion being cost-effective increased with the value put on extra effect units gained by using surgery. In a full economic evaluation randomized controlled trial, including 284 of 294 patients with therapy resistant chronic low back pain (CLBP) for at least 2 years, we found that lumbar fusion was more costly compared with nonspecific nonsurgical treatment 2 years after treatment started. Treatment effects were significantly better after surgery, including significantly more patients returning to work. In this light, lumbar fusion may be a valid option in select patients with CLBP. There was no obvious advantage as far as costs and effects were concerned to use instrumented fusion instead of noninstrumented fusion in this select patient category.

The authors' abstract, as published at the source. Spine, 2004 · DOI ↗