Cost-effectiveness of lumbar discectomy for the treatment of herniated intervertebral disc

Study Design. A cost-effectiveness analysis of lumbar discectomy based on existing efficacy data and newly gathered cost data. Objectives. For patients with herniated lumbar discs unresponsive to conservative management, surgery relieves pain more rapidly but at higher costs than continued medical therapy. We evaluated the cost-effectiveness of lumbar discectomy for these patients. Summary of Background Data. Effectiveness estimates were based on the results of a published trial of 126 herniated disc patients randomized to surgical or nonsurgical treatment. Quality of life values were based on a study of 83 subjects with low back pain. Treatment costs for herniated discs were estimated from insurance data for 372 patients treated surgically and 1803 treated medically. Methods. Efficacy results were weighted by quality of life values to estimate the quality-adjusted benefit of surgery. Cost-effectiveness was calculated in dollars per quality-adjusted year of life gained. Supplemental data sources for cost and effectiveness provided ranges for sensitivity analyses. Results. Surgery increased average quality-adjusted life expectancy by 0.43 years during the decade following treatment, a benefit similar to extending a healthy life by 5 months. Reimbursements for surgical patients were $12,550 more than for medical patients. Nondiscounted and 5% discounted cost-effectiveness were $29,200 and $33,900 per quality-adjusted year of life gained. Supplemental analyses confirmed the base-case effectiveness estimates but suggested that the cost of discectomy was overestimated. Replacing the main cost estimate with one based on HMO patients lowered discectomy's cost to $12,000 per quality-adjusted life-year gained. Conclusion. For carefully selected patients with herniated discs, surgical discectomy is a cost-effective treatment. Discectomy's favorable cost-effectiveness results from its substantial effect on quality of life and moderate costs.