Cost effectiveness of outpatient lumbar discectomy

• Type: Article in International Scientific Journal
• Date: 2021

Authors

Linhares, D (Author) Other; Fonseca, JA (Author) Other; da Silva, MR (Author) Other; Conceicao, F (Author) Other; Sousa, A (Author) Other; Sousa Pinto, B (Author) FMUP; Neves, N (Author) FMUP

Journal

Title: Cost Effectiveness and Resource Allocation

Vol. 19

ISSN: 1478-7547

Publisher: Springer Nature

Indexing

ISI Web of Knowledge - 9 Citations

Scopus - 10 Citations

Other information

Authenticus ID: P-00T-PWR

DOI: 10.1186/s12962-021-00272-w

Abstract (EN): Background Microdiscectomy is the most commonly performed spine surgery and the first transitioning for outpatient settings. However, this transition was never studied, in what comes to cost-utility assessment. Accordingly, this economic study aims to access the cost-effectiveness of outpatient lumbar microdiscectomy when compared with the inpatient procedure. Methods This is a cost utility study, adopting the hospital perspective. Direct medical costs were retrieved from the assessment of 20 patients undergoing outpatient lumbar microdiscectomy and 20 undergoing inpatient lumbar microdiscectomy Quality-adjusted life-years were calculated from Oswestry Disability Index values (ODI). ODI was prospectively assessed in outpatients in pre and 3- and 6-month post-operative evaluations. Inpatient ODI data were estimated from a meta-analysis. A probabilistic sensitivity analysis was performed and incremental cost-effectiveness ratio (ICER) calculated. Results Outpatient procedure was cost-saving in all models tested. At 3-month assessment ICER ranged from euro135,753 to euro345,755/QALY, higher than the predefined threshold of euro60,000/QALY gained. At 6-month costs were lower and utilities were higher in outpatient, overpowering the inpatient procedure. Probabilistic sensitivity analysis showed that in 65% to 73% of simulations outpatient was the better option. The savings with outpatient were about 55% of inpatient values, with similar utility scores. No 30-day readmissions were recorded in either group. Conclusion This is the first economic study on cost-effectiveness of outpatient lumbar microdiscectomy, showing a significant reduction in costs, with a similar clinical outcome, proving it cost-effective.

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 11