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Cost-effectiveness study supports preoperative cognitive-behavioral therapy for lumbar spinal fusion
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Danish researchers of this randomized clinical trial found cognitive-behavioral therapy prior to lumbar spinal fusion is a cost-neutral and effective method to increase quality-adjusted life years in patients.
Researchers included 90 patients who underwent lumbar spinal fusion (LSF) and were randomly allocated to receive the usual care (control group) or the usual care and preoperative cognitive-behavioral therapy (CBT). Researchers evaluated quality-adjusted life years (QALYs), based on the EuroQol-5D, and pain-related disability, based on Oswestry Disability Index (ODI) scores, for each group.
Researchers observed a statistically significant difference of 0.071 QALYs in favor of the CBT group at 1-year follow-up. In addition, the CBT group experienced a significant reduction in disability from baseline at 3 months and 6 months compared with the control group. However, investigators found no such difference at 1 year.
Researchers also noted the CBT was at least a cost-neutral option for the patients.
“In a population of patients undergoing LSF for degenerative conditions, we found a 70% chance of preoperative CBT being cost-effective over usual care at a threshold of willingness-to-pay of €40,000 for 1 additional QALY. For an ODI gain of 15 points, we found a 90% probability of the CBT intervention being cost-effective already at threshold of €10,000,” the researchers wrote.
The researchers concluded CBT should be integrated into the preoperative and postoperative rehabilitation plan for this study population. – by Robert Linnehan
Disclosure: Researchers reported funds from The Danish Council for Strategic Research, The Health Research Fund of Central Denmark Region, The Danish Rheumatism Association and the Health Foundation.
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