Swiss Spine Registry collects ongoing total disc replacement data and other outcomes

A health technology assessment is done for each procedure in the government-mandated register.

The Swiss government mandated implementation of a national spine surgery registry, which features a collaborative effort between orthopaedic surgeons, academia and industry.

Cervical and lumbar total disc arthroplasty (TDA) and balloon-kyphoplasty procedures (BKP) are the first procedures to have cost and efficacy data tracked by the Swiss Spine Registry, according to Christoph Röder, MD, MPH.

In December, Swiss health officials started using information from a June 2007 report on TDA and BKP performed in Switzerland to determine reimbursement levels for the surgery.

"A positive decision was made under the condition of a prolonged documentation obligation for each implant and only for another year," Röder told Orthopaedics Today International. Officials will revisit TDA and BKP reimbursement in December, he said.

During a workshop at the 9th Annual Meeting of the Spine Society of Europe in Brussels, Röder provided attendees with updated information on registry progress.

Health technology assessment

The Swiss government has requested that a health technology assessment (HTA) initially be conducted on each spine procedure planned for inclusion in the registry, he said. To date, such procedures only include cervical and lumbar TDA and kyphoplasty, and 135 Swiss surgeons are participating in the registry.

While the Swiss Spine Society supervises the register, the Institute for Evaluation Research in Orthopaedic Surgery (IEFO) at the University of Bern, Switzerland, has implemented it and administers and manages the data.

"I think it is the first HTA component in the history of Swiss orthopaedics [that is] providing clear and documented data to the entire spine sector," Röder said in his presentation.

80% participation

Information for about 80% of all TDA cases performed in Switzerland have been included in the registry, which Röder said is "quite remarkable," given the relatively short turnaround time from start to implementation.

However, "The learning curve was long," mostly due to the many steps involved in organizing data registration and determining the optimal way to get results back into the hands of surgeons, industry and other stakeholders, he said.

Several things helped streamline and expedite the process, Röder added. For example, it was too time-consuming for many surgeons to learn a new piece of computer software just to track information they were already recording anyway. As a result, they requested a way to complete the forms by hand and then have them scanned at the IEFO.

Changed culture

The early efforts have already paid off, Röder said. In the case of TDA, the data were strong enough to change the minds of some health officials who were initially against reimbursing for the procedure.

"We have made a big change in the culture of medical documentation, and we think that in the future, this will be easier to do, especially if the Swiss Spine Registry is well-received," he explained.

The Swiss Spine Registry will eventually include other procedures. The next HTA is slated to be performed on interspinal implants, which includes posterior dynamic stabilization procedures, Röder said.

Questionnaires were recently finalized and are expected to start being used in late April, he said.

For more information:
Christoph Röder, MD, MPH, can be reached at MEM Research Center for Orthopaedic Surgery, IEFO, University of Bern, Stauffacherstr.78, CH-3014 Bern, Switzerland; +41-31-6315940; e-mail: christoph.roeder@memcenter.unibe.ch. He has no financial interest in any products or companies mentioned in this article.
References:
Röder C, Moulin P. Swiss Spine Registry: The case of governmentally mandated spine registry. Presented at the 9th Annual Meeting of the Spine Society of Europe. Oct. 2-6, 2007. Brussels.
Röder C, Moulin P, Aebi M. The SWISSspine registry. In Szpalski/Gunzburg/Ler Huec/Brayda-Bruno (eds.). Nonfusion Technolohies in Spine Surgery. Lippencott William & Wilkins, NY. 267-275. 2007.