title: Preoperative Cognitive-Behavioral Patient Education Versus Standard Care for Lumbar Spinal Fusion Patients: Economic Evaluation Alongside a Randomized Controlled Trial.
abstract: METHODS
  A cost-effectiveness analysis conducted alongside a randomized clinical trial.
  
  
  OBJECTIVE
  To assess the cost-effectiveness of a preoperative cognitive-behavioral therapy (CBT) intervention compared to usual care for patients undergoing lumbar spinal fusion surgery (LSF).
  
  
  BACKGROUND
  The clinical effectiveness of a preoperative CBT intervention for patients undergoing LSF has been investigated in a randomized clinical trial. Economic evaluation is however essential for decision makers to make informed choices regarding allocation of scarce resources.
  
  
  METHODS
  90 patients undergoing LSF were randomly allocated to usual care (control group) or usual care plus a preoperative CBT intervention (CBT group). Outcome parameters included quality-adjusted life years (QALY), based on the EQ-5D, and pain-related disability, based on the Oswestry disability index (ODI). Health care use and productivity loss were estimated from national registers.
  
  
  RESULTS
  One year after LSF the estimated QALY was significantly better for the CBT group with 0.710 (95% CI 0.670; 0.749) versus 0.636 (95% CI 0.5573; 0.687). For the ODI, the CBT group reported significantly larger disability reductions at 3 months (P = 0.003) and 6 months (P = 0.047), but not at 1 year (P = 0.082). There was no difference in the overall costs of the two groups (-€89 (95% CI -12,080; 11,902)), leading to a 70% probability of the CBT intervention being cost-effective at a willingness-to-pay of €40,000 for one additional QALY. For an additional gain of 15 ODI points the probability was 90% at a threshold of €10,000. These results remained largely unaffected by relevant sensitivity analyses, confirming the robustness of findings.
  
  
  CONCLUSIONS
  Preoperative CBT appears to be more effective and cost neutral when considering the overall health care sector and labor market perspective, supporting the implementation of preoperative CBT in the course of treatment for LSF surgery in a Danish context.
authors.affiliation: *Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark †Regional Hospital Silkeborg, Silkeborg, Denmark ‡Department of Public Health, Aarhus University, Aarhus, Denmark §Department of Clinical Medicine, Aarhus University, Aarhus, Denmark ¶Section of Social Medicine and Rehabilitation, Department of Public Health, Aarhus University, Aarhus, Denmark ||Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark **Centre of Research in Rehabilitation, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Nanna
authors.initials: N
authors.lastname: Rolving
authors.forename: Rikke
authors.initials: R
authors.lastname: Sogaard
authors.forename: Claus Vinther
authors.initials: CV
authors.lastname: Nielsen
authors.forename: Finn Bjarke
authors.initials: FB
authors.lastname: Christensen
authors.forename: Cody
authors.initials: C
authors.lastname: Bünger
authors.forename: Lisa Gregersen
authors.initials: LG
authors.lastname: Oestergaard
mesh_terms: D000293:Adolescent; D000328:Adult; D001416:Back Pain; D015928:Cognitive Behavioral Therapy; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods* / Q000706:statistics & numerical data*; D011300:Preoperative Care / Q000379:methods*; D011788:Quality of Life; D013123:Spinal Fusion / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult