Study: 2-year cost-effectiveness equivalent for LLIF, TLIF

PHOENIX — In a comparison of physician, hospital and other charges for single-level standalone lateral lumbar interbody fusion and single-level transforaminal lumbar interbody fusion, researchers found both procedures led to 2-year outcomes that were equivalent in cost-effectiveness.

Gurpreet Surinder Gandhoke, MD, and colleagues received the Mayfield Clinical Sciences Award for this research at the Spine Summit 2015: CNS/AANS Section on Disorders of the Spine & Peripheral Nerves Annual Meeting.

“We found the lateral lumber interbody fusion (LLIF) surgery costs an additional $35,347 to provide one additional quality-adjusted life year (QALY) compared with a transforaminal lumbar interbody fusion (TLIF),” Gandhoke said.

Gurpreet Surinder Gandhoke

Despite the additional cost, the researchers concluded both procedures produced an equivalent 2-year patient outcome with an equivalent cost-effectiveness profile.

Gandhoke said he decided to study this area because third-party payers sometimes reimburse for new technology at lower rates unless there are cost-effectiveness data to support its use.

He and colleagues calculated the incremental cost-effectiveness ratio (ICER) of both procedures and sought to determine any differences between them in the corresponding QALY calculations they performed using the EuroQol-5D (EQ-5D).

The EQ-5D results were collected directly and indirectly.

The investigators obtained costs for treating patients with degenerative spondylosis who had low back and leg pain from a single-center database in a unified health care system.

Gandhoke and colleagues wrote in the study, “We had the advantage of having one data bank at our institute that gave us the most accurate cost involved for all patients in both treatment groups; we were able to eliminate all estimation in our cost calculation from diagnosis to the 2-year follow-up mark. Again, we could estimate the most accurate cost to the third-party payor and thus to the health system of the nation.”

Single-level TLIF was performed in 45 patients and single-level LLIF was performed in 29 patients. The mean total cost of care following TLIF and LLIF was $53,038 and $55,464, respectively, which included costs from the time patients were diagnosed until 2 years postoperatively. The difference between the costs was not statistically significant.

“When the indirect costs were not accounted for in the ICER calculation, it was found that TLIF was similarly effective but more costly than LLIF, and the ICER estimated that TLIF cost an additional $34,753 to provide one additional QALY in comparison to LLIF. However, when the indirect costs were accounted for, we found that TLIF was insignificantly different in terms of cost of QALYs gained in comparison to LLIF. The ICER ratio revealed that LLIF costs an additional $35,347 to provide one additional QALY in comparison to TLIF,” the researchers wrote.

The outcome measures studied included the SF-36 physical component summary, Oswestry Disability Index and VAS scores for back and leg pain. “All of them were statistically better between the two groups,” Gandhoke said. – by Susan M. Rapp

Reference:

Gandhoke GS, et al. Oral Paper #105. Presented at: Spine Summit 2015: CNS/AANS Section on Disorders of the Spine & Peripheral Nerves Annual Meeting; March 4-7, 2015; Phoenix.

For more information:

Gurpreet Surinder Gandhoke, MD, can be reached at Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop St., Suite B-400, Pittsburgh, PA 15213; email: gandhokegs@upmc.edu.

Disclosure: Gandhoke reports the study was funded by the 2014 Sanford Larson Award.