Cost effectiveness of disc prosthesis versus lumbar fusion in patients with chronic low back pain: randomized controlled trial with 2-year follow-up

Eur Spine J (2011) 20:1001–1011. DOI 10.1007/s00586-010-1607-3

This  randomized  controlled  health  economic study assesses the cost-effectiveness of the concept of total disc replacement (TDR) (Charité/Prodisc/Maverick) when compared with the concept of instrumented lumbar fusion (FUS) [posterior lumbar fusion (PLF) /posterior lumbar interbody fusion (PLIF)]. Social and healthcare perspectives after 2 years are reported.

In all, 152 patients were randomized  to  either  TDR  (n = 80)  or  lumbar  FUS (n = 72). Cost to society (total mean cost/patient, Swedish kronor = SEK,  standard  deviation)  for  TDR  was  SEK 599,560  (400,272),  and  for  lumbar  FUS  SEK  685,919 (422,903) (ns). The difference was not significant: SEK 86,359 (-45,605  to 214,332). TDR was significantly less costly from a healthcare perspective, SEK 22,996 (1,202 to 43,055). Number of days on sick leave among those who returned to work was 185 (146) in the TDR group, and 252 (189) in the FUS group (ns). Using EQ-5D, the total gain in quality adjusted life years (QALYs) over 2 years was 0.41 units for TDR and 0.40 units for FUS (ns). Based on EQ- 5D,  the  incremental  cost-effectiveness  ratio  (ICER)  of using TDR instead of FUS was difficult to analyze due to the ‘‘non-difference’’ in treatment outcome, which is why cost/QALY  was  not  meaningful  to  define. Using  cost- effectiveness probabilistic analysis, the net benefit (with CI) was found to be SEK 91,359 (-73,643  to 249,114) (ns). We used the currency of 2006 where 1 EURO = 9.26 SEK and 1 USD = 7.38 SEK.

It was not possible to state whether TDR or FUS is more cost-effective after 2 years. Since  disc replacement and lumbar fusion are based on different conceptual approaches, it is important to follow these results over time.

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