title: Cost-effectiveness of lumbar discectomy and single-level fusion for spondylolisthesis: experience with the NeuroPoint-SD registry.
abstract: OBJECTIVE
  There is significant practice variation and uncertainty as to the value of surgical treatments for lumbar spine disorders. The authors' aim was to establish a multicenter registry to assess the efficacy and costs of common lumbar spinal procedures by using prospectively collected outcomes.
  
  
  METHODS
  An observational prospective cohort study was completed at 13 academic and community sites. Patients undergoing single-level fusion for spondylolisthesis or single-level lumbar discectomy were included. The 36-Item Short Form Health Survey (SF-36) and Oswestry Disability Index (ODI) data were obtained preoperatively and at 1, 3, 6, and 12 months postoperatively. Power analysis estimated a sample size of 160 patients: lumbar disc (125 patients) and lumbar listhesis (35 patients). The quality-adjusted life year (QALY) data were calculated using 6-dimension utility index scores. Direct costs and complication costs were estimated using Medicare reimbursement values from 2011, and indirect costs were estimated using the human capital approach with the 2011 US national wage index. Total costs equaled $14,980 for lumbar discectomy and $43,852 for surgery for lumbar spondylolisthesis.
  
  
  RESULTS
  There were 198 patients enrolled over 1 year. The mean age was 46 years (49% female) for lumbar discectomy (n = 148) and 58.1 years (60% female) for lumbar spondylolisthesis (n = 50). Ten patients with disc herniation (6.8%) and 1 with listhesis (2%) required repeat operation at 1 year. The overall 1-year follow-up rate was 88%. At 30 days, both lumbar discectomy and single-level fusion procedures were associated with significant improvements in ODI, visual analog scale, and SF-36 scores (p = 0.0002), which persisted at the 1-year evaluation (p < 0.0001). By 1 year, more than 80% of patients in each cohort who were working preoperatively had returned to work. Lumbar discectomy was associated with a gain of 0.225 QALYs over the 1-year study period ($66,578/QALY gained). Lumbar spinal fusion for Grade I listhesis was associated with a gain of 0.195 QALYs over the 1-year study period ($224,420/QALY gained).
  
  
  CONCLUSIONS
  This national spine registry demonstrated successful collection of high-quality outcomes data for spinal procedures in actual practice. These data are useful for demonstrating return to work and cost-effectiveness following surgical treatment of single-level lumbar disc herniation or spondylolisthesis. One-year cost per QALY was obtained, and this cost per QALY is expected to improve further by 2 years. This work sets the stage for real-world analysis of the value of health interventions.
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco, California;
authors.forename: Praveen V
authors.initials: PV
authors.lastname: Mummaneni
authors.forename: Robert G
authors.initials: RG
authors.lastname: Whitmore
authors.forename: Jill N
authors.initials: JN
authors.lastname: Curran
authors.forename: John E
authors.initials: JE
authors.lastname: Ziewacz
authors.forename: Rishi
authors.initials: R
authors.lastname: Wadhwa
authors.forename: Christopher I
authors.initials: CI
authors.lastname: Shaffrey
authors.forename: Anthony L
authors.initials: AL
authors.lastname: Asher
authors.forename: Robert F
authors.initials: RF
authors.lastname: Heary
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Cheng
authors.forename: R John
authors.initials: RJ
authors.lastname: Hurlbert
authors.forename: Andrea F
authors.initials: AF
authors.lastname: Douglas
authors.forename: Justin S
authors.initials: JS
authors.lastname: Smith
authors.forename: Neil R
authors.initials: NR
authors.lastname: Malhotra
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Dante
authors.forename: Subu N
authors.initials: SN
authors.lastname: Magge
authors.forename: Michael G
authors.initials: MG
authors.lastname: Kaiser
authors.forename: Khalid M
authors.initials: KM
authors.lastname: Abbed
authors.forename: Daniel K
authors.initials: DK
authors.lastname: Resnick
authors.forename: Zoher
authors.initials: Z
authors.lastname: Ghogawala
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003362:Cost-Benefit Analysis / Q000191:economics*; D017586:Diskectomy / Q000191:economics*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D013123:Spinal Fusion / Q000191:economics*; D013168:Spondylolisthesis / Q000191:economics* / Q000453:epidemiology / Q000601:surgery*
keywords: CPT = current procedural terminology; DRG = diagnosis-related group; HIPAA = Health Insurance Portability and Accountability Act; HRQOL = health-related quality of life; NPA = NeuroPoint Alliance; NeuroPoint-SD = NeuroPoint–Spinal Disorders; ODI = Oswestry Disability Index; QALY = quality-adjusted life year; RCT = randomized controlled trial; SF-12 and SF-36 = 12- and 36-Item Short Form Health Survey; SF-6D = 6-dimension utility index; SPORT = Spine Patient Outcomes Research Trial; cost; discectomy; fusion; outcome; quality-adjusted life year; spondylolisthesis