Three evidenced based studies were reviewed to determine how exactly more cost effective was surgery versus non-surgical treatment and minimally invasive spine surgery versus open spine surgery.
The first looked at the cost-effectiveness of surgical versus non-surgical treatment for lumbar disc herniations over 2 years. This followed patients who received a discectomy for an intervertebral disc herniation at 6 weeks, 3, 6, 12, and 24 months. It measured cost-effectiveness in terms of Quality Adjusted Life Years (QALY), which measures what a life in perfect health after a surgical intervention would be worth.
The intervention in the surgery group was a laminectomy/laminotomy. Patients who underwent surgery had significantly worse body pain, less physical function and a higher incidence of mental problems. Resource utilization and costs for each outpatient visit (physical therapy, diagnostic test, injections, devices and rehabilitation were collected). Along with the “direct” costs of the procedures themselves and the attendant medical care, “indirect” costs associated with EQ-SD, (being mobility, self-care, usual activities, pain and discomfort and anxiety and depression) were assigned a cost. It is important to measure these indirect costs, since two-thirds of the over $200 billion per year in low back pain costs are in direct, resulting in more residual treatment, lost wages and reduced productivity.
Indirect costs accounted for 57% of the costs in non-operative patients. Health outcomes, resulting in less residual treatment for the surgery patients were much better over two years following surgery. This resulted in a cost per Quality Adjusted Life Year for surgery of $34,355 for surgery versus $69,403 for non-operative patients.
A second study looked at the economics of minimally-invasive spine surgery (MIS). In this study the value of a health care intervention is defined as the quality of the intervention divided by the cost of the intervention measured over time. The current threshold dollar amount to determine if an intervention is cost effective is between $50,000 and $100,000 of QALY gained. In this study the cost per QALY for MIS was $21,389 less than for open surgery.
It was also found that the indirect costs for lumbar spinal fusion, the costs of production loss from work, absenteeism and disability exceeded the direct costs of diagnosis, treatment and therapy. When two level minimally invasive surgery was compared to posterior lumbar interbody fusion, the complication rates were 2.5% (MIS) and 71.2% (fusion) respectively. One study found that each complication resulted in a median additional cost of $4,278 and a 297% increase in hospital length of stay.
Minimally invasive spine surgery (MIS) results in drastically reduced indirect costs such as work-related disability and residual care. The potential to more readily increase societal productivity may be the biggest advantage on minimally-invasive spine surgery economics.
Lastly, a study looked at the cost differences between open and minimally invasive instrumented spinal fusion surgeries. The average savings for minimally invasive surgery over open surgery was $2,825.37 or 10% of the total cost per patient. Again here, residual costs and indirect costs associated with open spine surgery increased the cost gap with minimally invasive surgery. Eighteen transfusions were required in the open group versus one in the MIS group. In the open group 37% required residual events, adding a cost of $2,131.54 for each event.
If you’re considering a surgical treatment for chronic spine pain, be it in the neck area, upper back or lower back, the Bonati Spine Procedures can provide a more economical alternative with less time spent recovering. Bonati Spine Institute surgeons are here to review your case and verify if and how our procedures can help.