title: Cost-effectiveness of the treatment of traumatic thoracolumbar spine fractures: Nonsurgical or surgical therapy?
abstract: BACKGROUND
  Spinal fractures can be an important cause for disabling back pain. Therefore, in judging the cost-effectiveness of nonsurgical or surgical therapy, not only direct costs but also the indirect costs should be calculated. In this prospective randomized study, the costs incurred by nonsurgically and surgically treated patients with a traumatic thoracolumbar spine fracture without neurological involvement were analysed.
  
  
  METHODS
  32 patients with a traumatic thoracolumbar spine fracture were prospectively randomized for operative or nonsurgical treatment. Patients were sent a questionnaire every three months to inquire about work-status, additional health costs and doctor visits. The patients who have minimum followup of two years were included.
  
  
  RESULTS
  Of thirty-two patients, 30 met the criterion of the followup period of at least two years. Fourteen patients received nonsurgical therapy, while 16 received surgical treatment. Direct costs of the treatment of nonsurgically treated patients were €10,608 ($12,730). For the operatively treated group, these costs were €18,769 ($22,523). Indirect costs resulted in a total of €219,187 ($263,025) per nonoperatively treated patient. In the operatively treated group, these costs were €66,004 ($79,206).
  
  
  CONCLUSIONS
  In the treatment of traumatic thoracolumbar spine fractures, the indirect costs exceed the direct costs by far and make up 95.4% of the total costs for treatment in nonsurgically treated patients and 71.6% of the total costs in the operative group. In view of cost-effectiveness, the operative therapy of traumatic thoracolumbar spine fractures is to be preferred.
authors.affiliation: Atrium Medisch Centrum Parkstad, Heerlen, the Netherlands.
authors.forename: Jan
authors.initials: J
authors.lastname: Siebenga
authors.forename: Michiel Jm
authors.initials: MJ
authors.lastname: Segers
authors.forename: Vincent Jm
authors.initials: VJ
authors.lastname: Leferink
authors.forename: Matthijs J
authors.initials: MJ
authors.lastname: Elzinga
authors.forename: Fred C
authors.initials: FC
authors.lastname: Bakker
authors.forename: Henk-Jan Ten
authors.initials: HJ
authors.lastname: Duis
authors.forename: Pol M
authors.initials: PM
authors.lastname: Rommens
authors.forename: Peter
authors.initials: P
authors.lastname: Patka