Cost-utility analysis of routine neurosurgical spinal surgery.
OBJECTIVE
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 Euro 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.
Räsänen
Pirjo
P
Group Administration, Helsinki and Uusimaa Hospital Group, Helsinki, Finland. pirjo.rasanen@hus.fi
Ohman
Juha
J
Sintonen
Harri
H
Ryynänen
Olli-Pekka
OP
Koivisto
Anna-Maija
AM
Blom
Marja
M
Roine
Risto P
RP
D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae; D003362:Cost-Benefit Analysis; D005260:Female; D006304:Health Status; D006306:Health Surveys; D017721:Hospital Costs; D006801:Humans; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000191:economics*; D011788:Quality of Life; D011843:Radiculopathy / Q000209:etiology / Q000601:surgery*; D013122:Spinal Diseases / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome