title: The 2-year cost-effectiveness of 3 options to treat lumbar spinal stenosis patients.
abstract: Lumbar spinal stenosis (LSS) may result from degenerative changes of the spine, which lead to neural ischemia, neurogenic claudication, and a significant decrease in quality of life. Treatments for LSS range from conservative management including epidural steroid injections (ESI) to laminectomy surgery. Treatments vary greatly in cost and success. ESI is the least costly treatment may be successful for early stages of LSS but often must be repeated frequently. Laminectomy surgery is more costly and has higher complication rates. Minimally invasive lumbar decompression (mild(®) ) is an alternative. Using a decision-analytic model from the Medicare perspective, a cost-effectiveness analysis was performed comparing mild(®) to ESI or laminectomy surgery. The analysis population included patients with LSS who have moderate to severe symptoms and have failed conservative therapy. Costs included initial procedure, complications, and repeat/revision or alternate procedure after failure. Effects measured as change in quality-adjusted life years (QALY) from preprocedure to 2 years postprocedure. Incremental cost-effectiveness ratios were determined, and sensitivity analysis conducted. The mild(®) strategy appears to be the most cost-effective ($43,760/QALY), with ESI the next best alternative at an additional $37,758/QALY. Laminectomy surgery was the least cost-effective ($125,985/QALY).
authors.affiliation: Outcomes Research, Cleveland Clinic, Cleveland, Ohio, U.S.A.
authors.forename: Belinda L
authors.initials: BL
authors.lastname: Udeh
authors.forename: Shrif
authors.initials: S
authors.lastname: Costandi
authors.forename: Jarrod E
authors.initials: JE
authors.lastname: Dalton
authors.forename: Raktim
authors.initials: R
authors.lastname: Ghosh
authors.forename: Hani
authors.initials: H
authors.lastname: Yousef
authors.forename: Nagy
authors.initials: N
authors.lastname: Mekhail
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D019299:Decompression, Surgical / Q000379:methods*; D006801:Humans; D007268:Injections, Epidural; D007796:Laminectomy / Q000379:methods*; D008159:Lumbar Vertebrae / Q000601:surgery*; D018803:Models, Economic; D011183:Postoperative Complications / Q000191:economics; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D013130:Spinal Stenosis / Q000191:economics* / Q000628:therapy
chemical_list: D000305:Adrenal Cortex Hormones
keywords: cost-effectiveness; economics; lower back pain; lumbar spinal stenosis; mild procedure; quality-adjusted life years; surgical procedures