title: Cost-effectiveness of multilevel hemilaminectomy for lumbar stenosis-associated radiculopathy.
abstract: BACKGROUND
  Laminectomy for lumbar stenosis-associated radiculopathy is associated with improvement in pain, disability, and quality of life. However, given rising health-care costs, attention has been turned to question the cost-effectiveness of lumbar decompressive procedures. The cost-effectiveness of multilevel hemilaminectomy for radiculopathy remains unclear.
  
  
  OBJECTIVE
  To assess the comprehensive medical and societal costs of multilevel hemilaminectomy at our institution and determine its cost-effectiveness in the treatment of degenerative lumbar stenosis.
  
  
  METHODS
  Prospective single cohort study.
  
  
  METHODS
  Fifty-four consecutive patients undergoing multilevel hemilaminectomy for lumbar stenosis-associated radiculopathy after at least 6 months of failed conservative therapy were included.
  
  
  METHODS
  Self-reported measures were assessed using an outcomes questionnaire that incorporated total back-related medical resource utilization, missed work, and improvement in leg pain (visual analog scale for leg pain [VAS-LP]), disability (Oswestry Disability Index [ODI]), quality of life (Short Form-12 [SF-12]), and health state values (quality-adjusted life years [QALYs], calculated from EuroQuol 5D [EQ-5D] with US valuation).
  
  
  METHODS
  Over a 2-year period, total back-related medical resource utilization, missed work, and improvement in leg pain (VAS-LP), disability (ODI), quality of life (SF-12), and health state values (QALYs, calculated from EQ-5D with US valuation) were assessed. Two-year resource use was multiplied by unit costs based on Medicare national allowable payment amounts (direct cost), and patient and caregiver workday losses were multiplied by the self-reported gross-of-tax wage rate (indirect cost). Mean total 2-year cost per QALY gained after multilevel hemilaminectomy was assessed.
  
  
  RESULTS
  Compared with preoperative health states reported after at least 6 months of medical management, a significant improvement in VAS-LP, ODI, and SF-12 (physical and mental components) was observed 2 years after multilevel hemilaminectomy, with a mean 2-year gain of 0.72 QALYs. Mean±standard deviation total 2-year cost of multilevel hemilaminectomy was $24,264±10,319 (surgery cost, $10,220±80.57; outpatient resource utilization cost, $3,592±3,243; and indirect cost, $10,452±9,364). Multilevel hemilaminectomy was associated with a mean 2-year cost per QALY gained of $33,700.
  
  
  CONCLUSIONS
  Multilevel hemilaminectomy improved pain, disability, and quality of life in patients with lumbar stenosis-associated radiculopathy. Total cost per QALY gained for multilevel hemilaminectomy was $33,700 when evaluated 2 years after surgery with Medicare fees, suggesting that multilevel hemilaminectomy is a cost-effective treatment of lumbar radiculopathy.
authors.affiliation: Department of Neurosurgery, Vanderbilt University Medical Center, 4347 Village at Vanderbilt, Nashville, TN 37232-8618, USA.
authors.forename: Scott L
authors.initials: SL
authors.lastname: Parker
authors.forename: Erin C
authors.initials: EC
authors.lastname: Fulchiero
authors.forename: Brandon J
authors.initials: BJ
authors.lastname: Davis
authors.forename: Owoicho
authors.initials: O
authors.lastname: Adogwa
authors.forename: Oran S
authors.initials: OS
authors.lastname: Aaronson
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Cheng
authors.forename: Clinton J
authors.initials: CJ
authors.lastname: Devin
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: McGirt
mesh_terms: D003362:Cost-Benefit Analysis; D019299:Decompression, Surgical / Q000191:economics; D005260:Female; D006801:Humans; D007796:Laminectomy / Q000191:economics* / Q000379:methods; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000191:economics*; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D011843:Radiculopathy / Q000191:economics / Q000209:etiology / Q000601:surgery; D020127:Recovery of Function; D013130:Spinal Stenosis / Q000150:complications / Q000191:economics* / Q000601:surgery*; D011795:Surveys and Questionnaires