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Type: Journal article
Title: ISSLS prize winner: Cost-effectiveness of two forms of circumferential lumbar fusion: A prospective randomized controlled trial
Author: Freeman, B.
Steele, N.
Sach, T.
Hegarty, J.
Soegaard, R.
Citation: Spine, 2007; 32(25):2891-2897
Publisher: Lippincott Williams & Wilkins
Issue Date: 2007
ISSN: 0362-2436
Statement of
Freeman, Brian J. C. ; Steele, Nicholas A. ; Sach, Tracey H. ; Hegarty, James ; Soegaard, Rikke
Abstract: Study Design. Economic evaluation alongside a prospective, randomized controlled trial from a secondary care National Health Service (NHS) perspective. Objective. To determine the cost-effectiveness of titanium cages (TC) compared with femoral ring allografts (FRA) in circumferential lumbar spinal fusion. Summary of Background Data. A randomized controlled trial has shown the use of TC to be clinically inferior to the established practice of using FRA in circumferential lumbar fusion. Health economic evaluation is urgently needed to justify the continued use of TC, given that this treatment is less effective and, all things being equal, is assumed more costly than FRA. Methods. Eighty-three patients were randomly allocated to receive either the TC or FRA as part of a circumferential lumbar fusion between 1998 and 2002. NHS costs related to the surgery and revision surgery needed during the trial period were monitored and adjusted to the base year (2005-2006 Pounds Sterling). The Short Form-6D (SF-6D) was administered before surgery and at 6, 12 and 24 months in order to elicit patient utility and subsequently Quality-Adjusted Life Years (QALYs) for the trial period. Return to paid employment was also monitored. Bootstrapped mean differences in discounted costs and benefits were generated in order to explore cost-effectiveness. Results. A significant cost difference of £1950 (95% CI, £849 to £3145) in favor of FRA was found. Mean QALYs per patient over the 24-month trial period were 0.0522 (SD, 0.0326) in the TC group and 0.1914 (SD, 0.0398) in the FRA group, producing a significant difference of -0.1392 (95% CI, -0.2349 to -0.0436). With regard to employment, incremental productivity costs were estimated at £185,171 in favor of FRA. Conclusion. From an NHS perspective, the trial data show that TC is not cost-effective in circumferential lumbar fusion. The use of FRA was both cheaper and generated greater QALY gains. In addition, FRA patients reported a greater return to work rate.
Keywords: Femur; Lumbar Vertebrae; Humans; Low Back Pain; Chronic Disease; Titanium; Radiography; Pain Measurement; Disability Evaluation; Treatment Outcome; Spinal Fusion; Bone Transplantation; Reoperation; Prospective Studies; Reproducibility of Results; Equipment Design; Orthopedic Fixation Devices; Quality-Adjusted Life Years; Time Factors; Cost of Illness; Awards and Prizes; Employment; Cost-Benefit Analysis; Health Care Costs; England; Surveys and Questionnaires
Description: Copyright © 2007 Lippincott Williams & Wilkins, Inc.
Rights: © 2007 Lippincott Williams & Wilkins, Inc.
RMID: 0020081144
DOI: 10.1097/BRS.0b013e31815b75e2
Appears in Collections:Orthopaedics and Trauma publications

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