The cost effectiveness of single-level instrumented posterolateral lumbar fusion at 5 years after surgery

Spine (Phila Pa 1976). 2012 Apr 20;37(9):769-74. doi: 10.1097/BRS.0b013e3181e03099.


Study design: Cost effectiveness analysis for single-level instrumented fusion during a 5-year postoperative interval.

Objective: To determine the cost/quality-adjusted life year (QALY) gained for single-level instrumented posterolateral lumbar fusion for degenerative lumbar spine conditions during a 5-year period.

Summary of background data: Cost/QALY has become a standard measure among healthcare economists because it is generic and can be used across medical treatments. Prior studies have reported widely variable estimates of cost/QALY for lumbar spine fusion. This variability may be related to factors including study design, sample population, baseline assumptions, and length of the observation period.

Methods: To determine QALY, the Short Form 6D (SF-6D), a utility index derived from the Short Form (36) Health Survey (SF-36) was used. Cost analysis was performed based on actual reimbursements from third-party payors, including those for the index surgical procedure, treatment of complications, emergency room outpatient visits, and revision surgery. A second cost analysis using only the contemporaneous Medicare Fee schedule was also performed, in addition to a subanalysis including indirect costs from days off work.

Results: The mean SF-6D health utility value showed a gradual increase throughout the follow-up period. The mean health utility value gained in each year postoperatively was 0.12, 0.14, 0.13, 0.15, and 0.15, for a cumulative 0.69 QALY improvement during the 5-year interval. Mean direct medical costs based on actual reimbursements for 5 years after surgery, including the index and revision procedures, was $22,708. The resultant cost per QALY gained at the 5-year postoperative interval was $33,018. The analogous mean direct cost based on Medicare reimbursement for 5 years was $20,669, with a resultant cost per QALY gained of $30,053. The mean total work productivity cost for 5 years was $14,377. The resultant total cost (direct and indirect) per QALY gained ranged from $53,949 to $53,914 at 5 years postoperatively.

Conclusion: In the future, surgeons will need to demonstrate cost-effectiveness as well as clinical efficacy in order to justify payment for medical and surgical interventions, including lumbar spine fusion. This study indicates that at 5-year follow-up, single-level instrumented posterolateral spine fusion is both effective and durable, resulting in a favorable cost/QALY gain compared to other widely accepted healthcare interventions.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Absenteeism
  • Adult
  • Aged
  • Ambulatory Care / economics
  • Chi-Square Distribution
  • Cost-Benefit Analysis
  • Emergency Service, Hospital / economics
  • Female
  • Health Care Costs*
  • Humans
  • Insurance, Health, Reimbursement / economics
  • Lumbar Vertebrae / surgery*
  • Male
  • Medicare / economics
  • Middle Aged
  • Models, Economic
  • Postoperative Complications / economics
  • Postoperative Complications / etiology
  • Postoperative Complications / therapy
  • Quality-Adjusted Life Years
  • Reoperation / economics
  • Spinal Fusion / adverse effects
  • Spinal Fusion / economics*
  • Spinal Fusion / instrumentation
  • Surveys and Questionnaires
  • Time Factors
  • Treatment Outcome
  • United States
  • Young Adult