Cost-effectiveness of lumbar artificial intervertebral disc replacement: Driven by the choice of comparator

Parkinson, B; Goodall, S; Thavaneswaran, P

Cost-effectiveness of lumbar artificial intervertebral disc replacement: Driven by the choice of comparator

Parkinson, B

Goodall, S

Thavaneswaran, P

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Publication Type:: Journal Article
Citation:: ANZ Journal of Surgery, 2013, 83 (9), pp. 669 - 675
Issue Date:: 2013-09-01

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Field	Value	Language
dc.contributor.author	Parkinson, B https://orcid.org/0000-0002-2137-0962	en_US
dc.contributor.author	Goodall, S https://orcid.org/0000-0001-6611-6565	en_US
dc.contributor.author	Thavaneswaran, P	en_US
dc.date.available	2012-09-17	en_US
dc.date.issued	2013-09-01	en_US
dc.identifier.citation	ANZ Journal of Surgery, 2013, 83 (9), pp. 669 - 675	en_US
dc.identifier.issn	1445-1433	en_US
dc.identifier.uri	http://hdl.handle.net/10453/23676
dc.description.abstract	Background: Lower back pain is a common and costly condition in Australia. This paper aims to conduct an economic evaluation of lumbar artificial intervertebral disc replacement (AIDR) compared with lumbar fusion for the treatment of patients suffering from significant axial back pain and/or radicular (nerve root) pain, secondary to disc degeneration or prolapse, who have failed conservative treatment. Methods: A cost-effectiveness approach was used to compare costs and benefits of AIDR to five fusion approaches. Resource use was based on Medicare Benefits Schedule claims data and expert opinion. Effectiveness and re-operation rates were based on published randomized controlled trials. The key clinical outcomes considered were narcotic medication discontinuation, achievement of overall clinical success, achievement of Oswestry Disability Index success and quality-adjusted life-years gained. Results: AIDR was estimated to be cost-saving compared with fusion overall ($1600/patient); however, anterior lumbar interbody fusion and posterolateral fusion were less costly by $2155 and $807, respectively. The incremental cost-effectiveness depends on the outcome considered and the comparator. Conclusions: AIDR is potentially a cost-saving treatment for lumbar disc degeneration, although longer-term follow-up data are required to substantiate this claim. The incremental cost-effectiveness depends on the outcome considered and the comparator, and further research is required before any firm conclusions can be drawn. © 2012 The Authors. ANZ Journal of Surgery © 2012 Royal Australasian College of Surgeons.	en_US
dc.relation.ispartof	ANZ Journal of Surgery	en_US
dc.relation.isbasedon	10.1111/ans.12009	en_US
dc.subject.classification	Surgery	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Low Back Pain	en_US
dc.subject.mesh	Radiculopathy	en_US
dc.subject.mesh	Treatment Outcome	en_US
dc.subject.mesh	Spinal Fusion	en_US
dc.subject.mesh	Reoperation	en_US
dc.subject.mesh	Models, Statistical	en_US
dc.subject.mesh	Models, Economic	en_US
dc.subject.mesh	Markov Chains	en_US
dc.subject.mesh	Quality-Adjusted Life Years	en_US
dc.subject.mesh	Cost-Benefit Analysis	en_US
dc.subject.mesh	Health Care Costs	en_US
dc.subject.mesh	Australia	en_US
dc.subject.mesh	Intervertebral Disc Displacement	en_US
dc.subject.mesh	Total Disc Replacement	en_US
dc.title	Cost-effectiveness of lumbar artificial intervertebral disc replacement: Driven by the choice of comparator	en_US
dc.type	Journal Article
utslib.citation.volume	9	en_US
utslib.citation.volume	83	en_US
utslib.for	1103 Clinical Sciences	en_US
utslib.for	1402 Applied Economics	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Business
pubs.organisational-group	/University of Technology Sydney/Strength - CHERE - Centre for Health Economics Research and Evaluation
utslib.copyright.status	closed_access
pubs.issue	9	en_US
pubs.publication-status	Published	en_US
pubs.volume	83	en_US

Abstract:

Background: Lower back pain is a common and costly condition in Australia. This paper aims to conduct an economic evaluation of lumbar artificial intervertebral disc replacement (AIDR) compared with lumbar fusion for the treatment of patients suffering from significant axial back pain and/or radicular (nerve root) pain, secondary to disc degeneration or prolapse, who have failed conservative treatment. Methods: A cost-effectiveness approach was used to compare costs and benefits of AIDR to five fusion approaches. Resource use was based on Medicare Benefits Schedule claims data and expert opinion. Effectiveness and re-operation rates were based on published randomized controlled trials. The key clinical outcomes considered were narcotic medication discontinuation, achievement of overall clinical success, achievement of Oswestry Disability Index success and quality-adjusted life-years gained. Results: AIDR was estimated to be cost-saving compared with fusion overall ($1600/patient); however, anterior lumbar interbody fusion and posterolateral fusion were less costly by $2155 and $807, respectively. The incremental cost-effectiveness depends on the outcome considered and the comparator. Conclusions: AIDR is potentially a cost-saving treatment for lumbar disc degeneration, although longer-term follow-up data are required to substantiate this claim. The incremental cost-effectiveness depends on the outcome considered and the comparator, and further research is required before any firm conclusions can be drawn. © 2012 The Authors. ANZ Journal of Surgery © 2012 Royal Australasian College of Surgeons.

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http://hdl.handle.net/10453/23676