title: Economic value of treating lumbar disc herniation in Brazil.
abstract: OBJECTIVE
  Lumbar discectomy is one of the most common surgical spine procedures. In order to understand the value of this surgical care, it is important to understand the costs to the health care system and patient for good results. The objective of this study was to evaluate for the first time the cost-effectiveness of spine surgery in Latin America for lumbar discectomy in terms of cost per quality-adjusted life year (QALY) gained for patients in Brazil.
  
  
  METHODS
  The authors performed a prospective cohort study involving 143 consecutive patients who underwent open discectomy for lumbar disc herniation (LDH). Patient-reported outcomes were assessed utilizing the SF-6D, which is derived from a 12-month variation of the SF-36. Direct medical costs included medical reimbursement, costs of hospital care, and overall resource consumption. Disability losses were considered indirect costs. A 4-year horizon with 3% discounting was applied to health-utilities estimates. Sensitivity analysis was performed by varying utility gain by 20%. The costs were expressed in Reais (R$) and US dollars ($), applying an exchange rate of 2.4:1 (the rate at the time of manuscript preparation).
  
  
  RESULTS
  The direct and indirect costs of open lumbar discectomy were estimated at an average of R$3426.72 ($1427.80) and R$2027.67 ($844.86), respectively. The mean total cost of treatment was estimated at R$5454.40 ($2272.66) (SD R$2709.17 [$1128.82]). The SF-6D utility gain was 0.044 (95% CI 0.03197-0.05923, p = 0.017) at 12 months. The 4-year discounted QALY gain was 0.176928. The estimated cost-utility ratio was R$30,828.35 ($12,845.14) per QALY gained. The sensitivity analysis showed a range of R$25,690.29 ($10,714.28) to R$38,535.44 ($16,056.43) per QALY gained.
  
  
  CONCLUSIONS
  The use of open lumbar discectomy to treat LDH is associated with a significant improvement in patient outcomes as measured by the SF-6D. Open lumbar discectomy performed in the Brazilian supplementary health care system provides a cost-utility ratio of R$30,828.35 ($12,845.14) per QALY. The value of acceptable cost-effectiveness will vary by country and region.
authors.affiliation: Department of Neurosurgery, Laboratory of Clinical Studies and Basic Models of Spinal Disorders and.
authors.forename: Asdrubal
authors.initials: A
authors.lastname: Falavigna
authors.affiliation: Department of Orthopaedics, Hospital Dr. Diego E. Thompson, Buenos Aires, Argentina;
authors.forename: Nicolas
authors.initials: N
authors.lastname: Scheverin
authors.affiliation: Department of Neurosurgery, Laboratory of Clinical Studies and Basic Models of Spinal Disorders and.
authors.forename: Orlando
authors.initials: O
authors.lastname: Righesso
authors.affiliation: Department of Neurosurgery, Laboratory of Clinical Studies and Basic Models of Spinal Disorders and.
authors.forename: Alisson R
authors.initials: AR
authors.lastname: Teles
authors.affiliation: Accountancy and Economic Sciences Center, University of Caxias do Sul, Caxias do Sul, Rio Grande do Sul, Brazil;
authors.forename: Maria Carolina
authors.initials: MC
authors.lastname: Gullo
authors.affiliation: Department of Neurosurgery, Vanderbilt University School of Medicine, Nashville, Tennessee;
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Cheng
authors.affiliation: Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, Missouri.
authors.forename: K Daniel
authors.initials: KD
authors.lastname: Riew
mesh_terms: D000328:Adult; D000368:Aged; D001938:Brazil; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D017586:Diskectomy / Q000191:economics* / Q000379:methods; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019057:Quality-Adjusted Life Years; D013130:Spinal Stenosis / Q000601:surgery*
keywords: Brazil; GDP = gross domestic product; HADS = Hospital Anxiety and Depression Scale; LDH = lumbar disc herniation; ODI = Oswestry Disability Index; QALY = quality-adjusted life year; SPORT = Spine Patient Outcomes Research Trial; SUS = Sistema Único de Saúde; WHO = World Health Organization; costs; health care economics; lumbar disc herniation; spine surgery