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106 Effect of Complications Within 90 Days on Cost-Utility Following Elective Surgery for Degenerative Lumbar Spine Disease
- Source :
- Neurosurgery. 63:145
- Publication Year :
- 2016
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2016.
-
Abstract
- Current health care systems are rapidly transitioning from the "fee-for service" to the "pay-for performance" model. With this paradigm shift, the providers and payers are constantly striving to determine tools to provide cost-effective and high-quality patient care. Therefore, it is vital to account for the complications and their effects on the cost and quality of life. We set forth to determine the cost-utility associated with complications after lumbar spine surgery.Total 407 patients undergoing elective surgery for degenerative lumbar pathology enrolled in the prospective longitudinal registry were included in the study. PROs: Oswestry Disability Index (ODI), numeric rating scale-Back and leg pain (BP, LP), general health (SF-12), and quality-of-life scores EQ-5D were recorded at baseline and 2 years after surgery. Two-year back-related medical resource utilization, missed work, and health state values (quality-adjusted life-years [QALYs], calculated from the EQ-5D with US valuation using the time-weighted area under the curve approach) were assessed. Mean 2-year cost per QALY gained after surgery was assessed. The patients were divided into groups with and without complications to compare the QALYs gained and the cost-utility in these groups.Fourteen percent (n = 58) of patients developed complications within 90 days after surgery. Most frequent surgical complication was surgical site infection (4.2%, n = 17), 1.5% (n = 6) had deep surgical site infections. There was a significant improvement in pain (BP, LP), disability (ODI), and general health scores (EQ-5D and SF-12) in both groups at postoperative 2 years (P < .0001). Patients with complications had lower mean cumulative 2-year QALY gained compared with those without complications (0.49 vs 0.57, P = .36). Cost-per-QALYs gained in patients with and without complications was $70 822 vs $45 831 (P = .03).Lumbar surgery provided a significant improvement in outcomes and gain in health state utility regardless of the occurrence of complications within the 90-day global period. The cost-utility, which was higher in patients with complications, was $70 822, which is within the range of commonly accepted threshold of willingness to pay. Clearly, measures focused on prevention of complications to reduce the cost and increase cost-utility.
- Subjects :
- 030222 orthopedics
medicine.medical_specialty
Lumbar spine disease
business.industry
Area under the curve
Oswestry Disability Index
Surgery
03 medical and health sciences
0302 clinical medicine
Lumbar
Cost utility
Health care
Medicine
Lumbar spine
Neurology (clinical)
Elective surgery
business
030217 neurology & neurosurgery
Subjects
Details
- ISSN :
- 0148396X
- Volume :
- 63
- Database :
- OpenAIRE
- Journal :
- Neurosurgery
- Accession number :
- edsair.doi...........134a7c366ae936c46f597cc19158bd1a