Economic value of treating lumbar disc herniation in Brazil

Abstract

<jats:sec> <jats:title>OBJECT</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>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).</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>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.</jats:p></jats:sec>

Direct medical costs after surgical or nonsurgical treatment for degenerative lumbar spinal disease: A nationwide matched cohort study with a 10-year follow-up

“…Although RCTs that focus on clinical outcomes can provide robust recommendations for spinal clinical practice [ 22 , 23 , 25 , 26 ], cost-effectiveness is important to physicians, patients and health insurance institutes [ 7 , 23 , 36 ]. These issues are quite serious for spinal disease, considering the recent increase in the number of cases, high cost of surgery/intervention and maintenance cost after treatment [ 3 , 36 ].…”

Direct medical costs after surgical or nonsurgical treatment for degenerative lumbar spinal disease: a nationwide matched cohort study with a 10-year follow-up

“…[37][38][39] Use of registered health care data for better management Although RCTs that focus on clinical outcomes can provide robust recommendations for spinal clinical practice, 25,26,28,29 cost-effectiveness is important to physicians, patients and health insurance institutes. 26,30,39,40 These issues are quite serious for spinal disease, considering the recent increase in the number of cases, high cost of surgery/intervention and maintenance cost after treatment. 8,39 Because the coverage policy of insurance in uences the practice pattern, safety and cost of spinal surgery, the stakeholders of insurance institutions should know the current utilization of healthcare services.…”

“…26,30,39,40 These issues are quite serious for spinal disease, considering the recent increase in the number of cases, high cost of surgery/intervention and maintenance cost after treatment. 8,39 Because the coverage policy of insurance in uences the practice pattern, safety and cost of spinal surgery, the stakeholders of insurance institutions should know the current utilization of healthcare services. 10,41,42 Although those issues have been analyzed by using medical records, the costs varied among societies to obtain a generalized picture of the utilization of medical services.…”

Why and how should we measure outcomes in spine surgery?

“…60 Our group recently published the first health economic analysis of spinal surgery in Brazil. 56 Using data from PRO collected routinely in patients undergoing surgery for lumbar disc herniation, we demonstrated that lumbar discectomy is a very cost-effective treatment for patients with lumbar disc herniation refractory to clinical treatment from private and public health care perspectives. 56 Thus, in addition to serving to evaluate patients' outcomes from their own perspectives, the routine collection of PRO instruments for patients with spinal disorders can be used for health economic analyses.…”

“…56 Using data from PRO collected routinely in patients undergoing surgery for lumbar disc herniation, we demonstrated that lumbar discectomy is a very cost-effective treatment for patients with lumbar disc herniation refractory to clinical treatment from private and public health care perspectives. 56 Thus, in addition to serving to evaluate patients' outcomes from their own perspectives, the routine collection of PRO instruments for patients with spinal disorders can be used for health economic analyses. We strongly believe that these initiatives are extremely important in the contemporary paradigm of value-based health care, principally in developing countries, where routine assessments of PRO are performed by a very limited proportion of spine care groups.…”