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Economic value of treating lumbar disc herniation in Brazil.

TitleEconomic value of treating lumbar disc herniation in Brazil.
Publication TypeJournal Article
Year of Publication2016
AuthorsFalavigna A, Scheverin N, Righesso O, Teles AR, Gullo MCarolina, Cheng JS, K Riew D
JournalJ Neurosurg Spine
Volume24
Issue4
Pagination608-14
Date Published2016 Apr
ISSN1547-5646
KeywordsAdult, Aged, Brazil, Cohort Studies, Cost-Benefit Analysis, Diskectomy, Female, Health Care Costs, Humans, Intervertebral Disc Displacement, Lumbar Vertebrae, Male, Middle Aged, Prospective Studies, Quality-Adjusted Life Years, Spinal Stenosis
Abstract

OBJECT: Lumbar discectomy is one of the most common surgical spine procedures. In order to understand the value of this surgical care, it is important to understand the costs to the health care system and patient for good results. The objective of this study was to evaluate for the first time the cost-effectiveness of spine surgery in Latin America for lumbar discectomy in terms of cost per quality-adjusted life year (QALY) gained for patients in Brazil.

METHODS: The authors performed a prospective cohort study involving 143 consecutive patients who underwent open discectomy for lumbar disc herniation (LDH). Patient-reported outcomes were assessed utilizing the SF-6D, which is derived from a 12-month variation of the SF-36. Direct medical costs included medical reimbursement, costs of hospital care, and overall resource consumption. Disability losses were considered indirect costs. A 4-year horizon with 3% discounting was applied to health-utilities estimates. Sensitivity analysis was performed by varying utility gain by 20%. The costs were expressed in Reais (R$) and US dollars ($), applying an exchange rate of 2.4:1 (the rate at the time of manuscript preparation).

RESULTS: The direct and indirect costs of open lumbar discectomy were estimated at an average of R$3426.72 ($1427.80) and R$2027.67 ($844.86), respectively. The mean total cost of treatment was estimated at R$5454.40 ($2272.66) (SD R$2709.17 [$1128.82]). The SF-6D utility gain was 0.044 (95% CI 0.03197-0.05923, p = 0.017) at 12 months. The 4-year discounted QALY gain was 0.176928. The estimated cost-utility ratio was R$30,828.35 ($12,845.14) per QALY gained. The sensitivity analysis showed a range of R$25,690.29 ($10,714.28) to R$38,535.44 ($16,056.43) per QALY gained.

CONCLUSIONS: The use of open lumbar discectomy to treat LDH is associated with a significant improvement in patient outcomes as measured by the SF-6D. Open lumbar discectomy performed in the Brazilian supplementary health care system provides a cost-utility ratio of R$30,828.35 ($12,845.14) per QALY. The value of acceptable cost-effectiveness will vary by country and region.

DOI10.3171/2015.7.SPINE15441
Alternate JournalJ Neurosurg Spine
PubMed ID26654336