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Cost-effectiveness for PLIF, TLIF vs. PLF varies by surgery
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Using a Markov model to compare the cost-effectiveness of posterior lumbar interbody fusion or transforaminal lumbar interbody fusion with noninterbody fusion and posterolateral fusion in patients with lumbar spondylolisthesis, researchers found after a second reoperation, the cost-effectiveness ratio began to tip in favor of posterolateral fusion.
A total of 137 patients with degenerative or isthmic spondylolisthesis who underwent first-time instrumented lumbar fusions were included in the study. Patients were split into cohorts based on the treatment they received, which included a noninterbody fusion and posterolateral fusion (PLF) cohort and a PLF plus posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF) cohort. A total of 83 patients underwent PLF and 54 underwent PLF plus PLIF/TLIF, according to the researchers.
The researchers calculated the cost data for short-term complications using charges accrued by the institution’s finance sector, and long-term outcomes cost data were calculated from the available literature. A cost-effectiveness ration (CER) was calculated subtracting the difference in cost of PLF plus PLIF/TLIF from the cost of PLF alone divided by the difference in quality of life-year (QALY).
Overall, the average time to reoperation was about 3.5 years, with patients in the PLF cohort exhibiting a mean QALY score of 2.81, compared with 2.66 in the PLIF/TLIF cohort (P = .110).
The mean PLF costs were statistically lower than those observed for patients undergoing index interbody fusion over 3.5 years ($48,822.76 vs. $54,827.05). Additionally, the reoperation rate for PLF patients was more than seven times higher than the PLIF/TLIF cohort, according to the researchers.
The researchers concluded that when second reoperations were included in the overall cost-effectiveness ratio, interbody fusion became $9,883.97 per QALY, leading to a moderate long-term cost savings with better functional outcomes. – by Robert Linnehan
Disclosure: Please see the study for a full list of relevant financial disclosures.
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