NSA Abstract LDH Analysis - Pamila Viswanathan and Team
Cost Effectiveness and Cost Utility Analysis of Treatment of Lumbar Disc Herniation:
Ways to Resolve SPORT and “unSPORTSmanlike conduct”
Pramila Viswanathan, M.D.
George Cybulski, M.D
Rupa Babu, M.D.
Leigh Jarboe, R.N.
Timothy Classen, Ph.D.
Healthcare reform will place increasing emphasis on the use of evidence-based medicine
to attempt to control costs as well as improve quality and efficacy of care. Such a study,
the Spine Patient Outcomes Research Trial (SPORT), has provided a confounding view
of the appropriateness of conservative versus surgical treatment of lumbar disc herniation
(LDH). Its findings, considered in context with measurements of cost and quality should
be reevaluated before formulating guidelines for treatment of LDH.
Economic parameters of cost-effectiveness (CE), cost utility (CU) and quality of
treatment modalities of LDH were analyzed using the Cost Effectiveness Analysis
Registry. Additional studies of alternative modalities were also reviewed.
Cost effectiveness analysis of treatment modalities of LDH measure the cost/health
outcome ratio. Studies of CE with prolonged longitudinal follow up (one to five years)
demonstrate a slight increase in cost of surgical treatment over “conservative” treatment.
However, when quality-adjusted life years (QALY), a measure that involves a weighting
system assigning value to the degree of quality of life, are compared between
conservative measures and microdiscectomy, microdiscectomy groups had significant
increase in quality results over conservatively treated groups.
LDH produces an acute state of ill being with accompanying significant disability.
Studies of treatment of LDH that merely compare longitudinal effects of treatment
(SPORT) fail to account for or measure the economic significance of accompanying
disability which is significant in the near term. Conservative measures are barely cost
effective overall in these studies and decidedly economically disadvantageous when
quality measures (QALY) are utilized. Patients with LDH treated surgically resolve their
symptoms and return to full activities of daily living quicker, resulting in overall
increased productivity and increased QALYs. Such findings should be emphasized in the
formulation of evidence based medicine guidelines.