Lumbar decompression with and without fusion: Which is more cost effective?

Spine

Spinal decompression on its own is more cost-effective than the procedure combined with spinal fusion in patients with lumbar stenosis with associated degenerative spondylolisthesis, according to a study in the June 15 issue of Spine.

Researchers used a multistate Markov model to create a hypothetical cohort of patients with lumbar stenosis with associated spondylolisthesis needing surgery. Data on clinical improvement, costs and reoperation were generated from randomized trial evidence and meta-analyses of prospective studies and cohorts. Results were compared with a willingness-to-pay threshold of $100,000 over a two-year time horizon.

The study found the incremental costs and utility of decompression and fusion relative to only decompression were $12,778 and 0.00529 aggregated quality adjusted life years. Corresponding incremental cost-effectiveness ratio of $2,416,281 exceeded the willingness to pay threshold of $100,000.

The study concluded: "Within the context of contemporary surgical data, DF is not cost-effective compared with DA in the surgical management of lumbar stenosis with associated spondylolisthesis over a two-year time horizon."

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