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Surgical discectomy is cost effective for
certain patients with herniated discs
Lumbar discectomy for carefully selected patients who have
herniated discs and do not respond to nonsurgical care provides
substantial benefit and is reasonably cost effective, according
to a cost-effectiveness analysis by the Back Pain Patient
Outcomes Research Team (PORT). The cost effectiveness of
discectomy (surgical removal of a disc) is $29,200 to $33,900 per
quality-adjusted year of life gained and may be as low as
$12,000. This compares very favorably with other widely used
therapies, such as coronary artery bypass grafting for heart
disease and medical therapy for moderate hypertension. Discectomy
also increases average quality-adjusted life expectancy by nearly
half a year.
This finding of cost-effectiveness may aid physicians and
patients, who often find it difficult to decide whether surgery
for a herniated disc is worth the risks and costs. This procedure
can relieve pain more rapidly for those who fail to respond to
medical management. But it is $10,000 more than the cost for
continued medical treatment, and the advantage may be only
temporary. Patients undergoing the surgery sometimes find that
they have the same level of low back pain 4 or 10 years later as
those who had no surgery for this often self-limiting
condition.
Led by Richard A. Deyo, M.D., M.P.H., of the University of
Washington, and supported by the Agency for Health Care Policy
and Research (HS06344), the research team used existing efficacy
data of a published trial of 126 herniated disc patients
randomized to surgical or nonsurgical treatment, as well as newly
gathered cost data. They calculated cost-effectiveness in dollars
per quality-adjusted year of life gained. Patients in the trials
had undergone 2-6 weeks of medical treatment and were still
experiencing pain, had herniated discs on myelogram (spinal x-ray
with contrast medium in the spinal canal), and usually showed
abnormal neurologic findings on physical exam.
More details are in "Cost-effectiveness of lumbar discectomy for
the treatment of herniated vertebral disc," by Alex D. Malter,
M.D., M.P.H., Eric B. Larson, M.D., M.P.H., Nicole Urban, Sc.D.,
and Dr. Deyo, in Spine 21(9), pp. 1048-1055, 1996.
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