title: Function after spinal treatment, exercise, and rehabilitation: cost-effectiveness analysis based on a randomized controlled trial.
abstract: METHODS
  Cost-effectiveness analysis alongside a factorial randomized controlled trial.
  
  
  OBJECTIVE
  To assess the cost-effectiveness of a rehabilitation program and/or an education booklet each compared with usual care for the postoperative management of patients undergoing discectomy or lateral nerve root decompression surgery.
  
  
  BACKGROUND
  There is little knowledge about the cost-effectiveness of postoperative management of patients after spinal surgery.
  
  
  METHODS
  A total of 338 patients were recruited into the study between June 2005 and March 2009. Patients were randomized to rehabilitation only, booklet only, rehabilitation plus booklet, or usual care only. Interactions between booklet and rehabilitation were nonsignificant; hence, we compare booklet versus no booklet and rehabilitation versus no rehabilitation. We adopt an English National Health Service and personal social services perspective. Data on outcomes and costs are based on patient level data from the trial. A 1-year time horizon was used. Outcomes were measured in terms of quality-adjusted life years. Health-related quality of life was reported by patients using the EuroQol-5D (EQ-5D). A comprehensive range of health service contacts were included in the cost analysis.
  
  
  RESULTS
  There were no significant differences in costs or outcomes associated with either intervention. Mean incremental costs and mean quality-adjusted life years gained per patient of booklet versus no booklet were -£87 (95% CI: -£1221 to £1047) and -0.023 (95% CI: -0.068 to 0.023), respectively. Figures for rehabilitation versus no rehabilitation were £160 (95% CI: -£984 to £1304) and 0.002 (95% CI: -0.044 to 0.048), respectively. Neither intervention was cost-effective when compared with the threshold range commonly used to judge whether or not an intervention is cost-effective in the English National Health Service.
  
  
  CONCLUSIONS
  Cost-effectiveness evidence does not support use of booklet over no booklet or rehabilitation over no rehabilitation for the postoperative management of patients after spinal surgery.
authors.affiliation: Research Department of Epidemiology and Public Health, University College London, London, UK. steve.morris@ucl.ac.uk
authors.forename: Stephen
authors.initials: S
authors.lastname: Morris
authors.forename: Tim P
authors.initials: TP
authors.lastname: Morris
authors.forename: Alison H
authors.initials: AH
authors.lastname: McGregor
authors.forename: Caroline J
authors.initials: CJ
authors.lastname: Doré
authors.forename: Konrad
authors.initials: K
authors.lastname: Jamrozik
mesh_terms: D003362:Cost-Benefit Analysis; D019299:Decompression, Surgical / Q000009:adverse effects / Q000191:economics*; D004185:Disability Evaluation; D017586:Diskectomy / Q000009:adverse effects / Q000191:economics*; D005081:Exercise Therapy / Q000191:economics*; D017048:Health Care Costs; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008131:London; D018803:Models, Economic; D010174:Pamphlets; D010353:Patient Education as Topic; D011182:Postoperative Care / Q000191:economics*; D011183:Postoperative Complications / Q000175:diagnosis / Q000191:economics* / Q000209:etiology / Q000628:therapy*; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012046:Rehabilitation / Q000191:economics; D013126:Spinal Nerve Roots / Q000601:surgery*; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome