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Two-year data show no cost effectiveness differences between lumbar TDR and fusion

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ORLANDO, Fla. — Following a full cost analysis of direct and indirect costs related to lumbar total disc replacement and fusion surgery, Swedish investigators could not determine whether one procedure was more cost-effective than the other.

“It was hard for us to conclude whether TDR (total disc replacement) or instrumented fusion was cost effective 2 years after the surgery,” said Ralph Hasserius, MD, PhD, who presented the study at the 2010 Annual Meeting of the North American Spine Society on behalf of Peter Fritzell, MD, PhD, and colleagues.

He said they intend to follow these patients longer to see if time will reveal differences between the groups.

Fritzell and colleagues conducted the randomized controlled trial at Sweden’s busiest spine center in Falun, tracking all relevant direct and indirect costs for both procedures performed between 2003 and 2005. Their study included 152 patients, aged 20 to 55 years old, with 80 patients in the TDR group and 72 patients in the lumbar fusion group.

Investigators also sought to determine whether there was some value for the expense associated with implanting disc prostheses. They found an actual cost to society 2 years after the operations of $400,272 for TDR vs. $685,919 for lumbar fusion. They attributed the higher costs in the fusion group to added sick leave days.

“From the health care picture, the TDR was less costly. From a societal perspective, there was no significant difference,” Hasserius said. He told OrthoSupersite.com that with longer follow-up costs could increase in the fusion group, as those patients may be at risk for added surgeries or treatment for adjacent level disc disease.

Reference:

Fritzell P, Berg S, Tullberg T, et al. A full economic evaluation of disc prosthesis vs. lumbar fusion in patients with chronic low back pain: A randomized controlled trial with 2-year follow up. Paper #82. Presented at the 2010 Meeting of the North American Spine Society. Oct. 5-9. Orlando, Fla.

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