title: Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 3: assessment of economic outcome.
abstract: A comprehensive economic analysis generally involves the calculation of indirect and direct health costs from a societal perspective as opposed to simply reporting costs from a hospital or payer perspective. Hospital charges for a surgical procedure must be converted to cost data when performing a cost-effectiveness analysis. Once cost data has been calculated, quality-adjusted life year data from a surgical treatment are calculated by using a preference-based health-related quality-of-life instrument such as the EQ-5D. A recent cost-utility analysis from a single study has demonstrated the long-term (over an 8-year time period) benefits of circumferential fusions over stand-alone posterolateral fusions. In addition, economic analysis from a single study has found that lumbar fusion for selected patients with low-back pain can be recommended from an economic perspective. Recent economic analysis, from a single study, finds that femoral ring allograft might be more cost-effective compared with a specific titanium cage when performing an anterior lumbar interbody fusion plus posterolateral fusion.
authors: Alan and Jacqueline Stuart Spine Research Center, Department of Neurosurgery, Lahey Clinic, Burlington, and Tufts University School of Medicine, Boston, Massachusetts;
authors: Zoher
authors: Z
authors: Ghogawala
authors: Robert G
authors: RG
authors: Whitmore
authors: William C
authors: WC
authors: Watters
authors: Alok
authors: A
authors: Sharan
authors: Praveen V
authors: PV
authors: Mummaneni
authors: Andrew T
authors: AT
authors: Dailey
authors: Tanvir F
authors: TF
authors: Choudhri
authors: Jason C
authors: JC
authors: Eck
authors: Michael W
authors: MW
authors: Groff
authors: Jeffrey C
authors: JC
authors: Wang
authors: Daniel K
authors: DK
authors: Resnick
authors: Sanjay S
authors: SS
authors: Dhall
authors: Michael G
authors: MG
authors: Kaiser
mesh_terms: D003362:Cost-Benefit Analysis; D019317:Evidence-Based Medicine; D006801:Humans; D008159:Lumbar Vertebrae / Q000473:pathology / Q000601:surgery*; D018803:Models, Economic; D017410:Practice Guidelines as Topic; D011788:Quality of Life; D013122:Spinal Diseases / Q000191:economics* / Q000473:pathology / Q000601:surgery*; D013123:Spinal Fusion / Q000191:economics* / Q000592:standards*
keywords: ALIF = anterior lumbar inter-body fusion; CCR = cost-to-charge ratio; CMS = Center for Medicare and Medicaid Services; CPT = Current Procedural Terminology; DRG = Diagnosis-Related Group; FRA = femoral ring allograft; HR-QOL = health-related quality of life; ICBG = iliac crest bone graft; ICD = International Classification of Diseases; ICER = incremental cost-effectiveness ratio; LOS = length of hospital stay; MIS = minimally invasive surgery; ODI = Oswestry Disability Index; QALY = quality-adjusted life year; SEK = Swedish kronor; SF-36 = 36-Item Short Form Health Survey; SPORT = Spine Patient Outcomes Research Trial; TC = titanium cage; TDR = total lumbar disc replacement; TLIF = transforaminal lumbar interbody fusion; UK = United Kingdom; VAS = visual analog scale; cost-effectiveness; fusion; lumbar spine; outcomes; practice guidelines; rhBMP-2 = recombinant human bone morphogenetic protein–2