Cost-effectiveness of current treatment strategies for lumbar spinal stenosis: nonsurgical care, laminectomy, and X-STOP.
OBJECT Standard treatment options for patients with lumbar spinal stenosis include nonoperative therapies as well as decompressive laminectomy. The introduction of interspinous decompression devices such as the X-STOP has broadened treatment options, but data comparing these treatment strategies are lacking. The object of this study was to provide a cost-effectiveness analysis of laminectomy, interspinous decompression, and nonoperative treatment for patients with lumbar stenosis. METHODS The authors performed a structured literature review of lumbar stenosis and constructed a cost-effectiveness model. Using conservative treatment, decompressive laminectomy, and placement of X-STOP as the treatment arms, their primary analysis evaluated the optimal treatment strategy for a patient with lumbar stenosis at a 2-year time horizon. Secondary analyses were done to compare cases in which patients required single-level procedures with those in which multilevel procedures were required as well as to examine the outcomes for a 4-year time horizon. Outcomes were calculated using quality-adjusted life years and costs were considered from the perspective of society. RESULTS Laminectomy was found to be the most effective treatment strategy, followed by X-STOP and then conservative treatment at a 2-year time horizon. Both surgical procedures were more costly than conservative treatment. Because laminectomy was both more effective and less costly than X-STOP, it is said to dominate overall. When single level procedures were considered alone, laminectomy was more effective but also more costly than X-STOP. CONCLUSIONS Lumbar laminectomy appears to be the most cost-effective treatment strategy for patients with symptomatic lumbar spinal stenosis.
Burnett
Mark G
MG
Department of Neurosurgery, NeuroTexas Institute, Austin, Texas, USA. burnettmg@hotmail.com
Stein
Sherman C
SC
Bartels
Ronald H M A
RH
D001696:Biomechanical Phenomena; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D019299:Decompression, Surgical / Q000191:economics / Q000295:instrumentation / Q000379:methods*; D004185:Disability Evaluation; D006801:Humans; D007796:Laminectomy / Q000191:economics / Q000379:methods*; D008159:Lumbar Vertebrae / Q000601:surgery*; D009984:Orthopedic Fixation Devices; D019057:Quality-Adjusted Life Years; D013130:Spinal Stenosis / Q000191:economics / Q000601:surgery*