Cha-Ching! Counting the Cost of Lumbar FusionMost of the costs to take care of low back pain (LBP) patients occur in those who are on sick leave six months or more. The total costs of LBP remain high in Europe and the United States. Reports indicate that as much as two percent of the gross national product in the United States is spent on health care costs for LBP.
This study looks at the cost of lumbar fusion for LBP. Costs are compared to patients who haven't had surgery. The number of lumbar fusions has increased 100 percent in the last 10 years. Is it worth the cost? Does it help? These are the questions researchers in Sweden looked at in a group of 284 adults with chronic LBP. Doctors at 19 clinics joined in this study.
The results of this study show that surgical treatment was much more costly than treatment without surgery. But it was also more effective. The group without surgery had nonoperative therapy that didn't help. They were referred to as the therapy resistant group.
Patients were followed for two years after treatment. More patients could go back to work after lumbar fusion than in the nonsurgical group. Results didn't seem to depend on the type of fusion used. Fusion patients all had equal results. Measures used to assess results included pain levels, level of disability, and return to work.
The authors reported all the costs for treatment of LBP. There were direct costs such as hospital care, drug use, and doctor bills. Indirect costs were also reported. These included lost days at work, lost productivity, and the cost of family support.
The cost of surgical care was about twice as much as nonsurgical treatment. However, twice as many patients in the fusion group improved, and twice as many returned to work full-time. More patients returned to work part-time in the fusion group, too.
The authors conclude that lumbar fusion is a good cost savings overall for society in cases of chronic LBP. The type of fusion didn't matter in this study, so perhaps the simpler, less expensive fusion method should be used more often. More study is needed to look at this factor.
Peter Fritzell, MD, PhD, et al. Cost-Effectiveness of Lumbar Fusion and Nonsurgical Treatment for Chronic Low Back Pain in the Swedish Lumbar Spine Study: A Multicenter, Randomized, Controlled Trial from the Swedish Lumbar Spine Study Group. In Spine. February 15, 2004. Vol. 29. No. 4. Pp. 421-434.
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