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Circumferential fusion better than posterolateral fusion for chronic low back pain

Researchers found the circumferential approach cheaper and significantly more effective in a long-term QALY study.

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BRUSSELS — Danish spine researchers found that circumferential fusion offered more cost savings and value than posterolateral fusion in a long-term comparison of treatment methods for severe, chronic low back pain.

Investigators sought to measure the incremental cost per quality-adjusted-life-year (QALY) when comparing circumferential fusion to posterolateral fusion (PLF) according to "a long-term societal perspective," said Finn B. Christensen, MD, of Aarhus, Denmark, at the 9th Annual Meeting of the Spine Society of Europe, here.

Christensen and colleagues randomly assigned 146 patients to either circumferential or posterolateral fusion and followed them for 4 to 8 years postoperatively. The investigators used the European Quality of Life questionnaire to measure health-related quality of life, and they calculated costs based on a full-scale societal perspective according to 2004 U.S dollar figures.

The researchers also valued productivity costs according to the friction cost method; costs as well as effects were discounted. The researchers then calculated arithmetic means and 95% bias-corrected bootstrapped confidence intervals, he said. Nonparametric statistics were used for tests of statistical significance.

"For each QALY gained by performing circumferential fusion, the incremental saving was estimated at $49,306 [mean]," Christensen said.

The results proved to be strong to various sensitivity analyses, he added.

"Only a differentiated underestimation of patients' needs for postoperative household help against the circumferential approach could alter the dominance [of circumferential fusion]," he said. However, the probability of cost-effectiveness was approximately 85%, given a threshold for willingness to pay of $50,000 per QALY.

Ultimately, "Circumferential fusion is dominant over instrumented PLF in terms of being significantly cheaper and better" based on a long-term societal perspective — a finding that could influence how orthopedic spine surgeons approach low back pain treatment, Christensen said.

For more information:

• Soegaard R, B?nger CE, Christiansen T, Christensen FB. Circumferential fusion is dominant over posterolateral fusion in a long-term perspective. Cost-utility evaluation of a randomized, controlled trial in severe, chronic low back pain. #31. Presented at the 9th Annual Meeting of the Spine Society of Europe. Oct. 2-6, 2007. Brussels.