Cost-effectiveness of multilevel hemilaminectomy for lumbar stenosis-associated radiculopathy

Scott L. Parker, Erin C. Fulchiero, Brandon J. Davis, Owoicho Adogwa, Oran S. Aaronson, Joseph S. Cheng, Clinton J. Devin, Matthew J. McGirt

Research output: Contribution to journalArticle

46 Scopus citations

Abstract

Background context: Laminectomy for lumbar stenosis-associated radiculopathy is associated with improvement in pain, disability, and quality of life. However, given rising health-care costs, attention has been turned to question the cost-effectiveness of lumbar decompressive procedures. The cost-effectiveness of multilevel hemilaminectomy for radiculopathy remains unclear. Purpose: To assess the comprehensive medical and societal costs of multilevel hemilaminectomy at our institution and determine its cost-effectiveness in the treatment of degenerative lumbar stenosis. Study design: Prospective single cohort study. Patient sample: Fifty-four consecutive patients undergoing multilevel hemilaminectomy for lumbar stenosis-associated radiculopathy after at least 6 months of failed conservative therapy were included. Outcome measures: Self-reported measures were assessed using an outcomes questionnaire that incorporated total back-related medical resource utilization, missed work, and improvement in leg pain (visual analog scale for leg pain [VAS-LP]), disability (Oswestry Disability Index [ODI]), quality of life (Short Form-12 [SF-12]), and health state values (quality-adjusted life years [QALYs], calculated from EuroQuol 5D [EQ-5D] with US valuation). Methods: Over a 2-year period, total back-related medical resource utilization, missed work, and improvement in leg pain (VAS-LP), disability (ODI), quality of life (SF-12), and health state values (QALYs, calculated from EQ-5D with US valuation) were assessed. Two-year resource use was multiplied by unit costs based on Medicare national allowable payment amounts (direct cost), and patient and caregiver workday losses were multiplied by the self-reported gross-of-tax wage rate (indirect cost). Mean total 2-year cost per QALY gained after multilevel hemilaminectomy was assessed. Results: Compared with preoperative health states reported after at least 6 months of medical management, a significant improvement in VAS-LP, ODI, and SF-12 (physical and mental components) was observed 2 years after multilevel hemilaminectomy, with a mean 2-year gain of 0.72 QALYs. Mean±standard deviation total 2-year cost of multilevel hemilaminectomy was $24,264±10,319 (surgery cost, $10,220±80.57; outpatient resource utilization cost, $3,592±3,243; and indirect cost, $10,452±9,364). Multilevel hemilaminectomy was associated with a mean 2-year cost per QALY gained of $33,700. Conclusions: Multilevel hemilaminectomy improved pain, disability, and quality of life in patients with lumbar stenosis-associated radiculopathy. Total cost per QALY gained for multilevel hemilaminectomy was $33,700 when evaluated 2 years after surgery with Medicare fees, suggesting that multilevel hemilaminectomy is a cost-effective treatment of lumbar radiculopathy.

Original languageEnglish (US)
Pages (from-to)705-711
Number of pages7
JournalSpine Journal
Volume11
Issue number8
DOIs
StatePublished - Aug 1 2011
Externally publishedYes

Keywords

  • Cost-effectiveness
  • Laminectomy
  • Multilevel unilateral decompression

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine
  • Clinical Neurology

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    Parker, S. L., Fulchiero, E. C., Davis, B. J., Adogwa, O., Aaronson, O. S., Cheng, J. S., Devin, C. J., & McGirt, M. J. (2011). Cost-effectiveness of multilevel hemilaminectomy for lumbar stenosis-associated radiculopathy. Spine Journal, 11(8), 705-711. https://doi.org/10.1016/j.spinee.2011.04.024