Introduction: Current health-care systems is rapidly transitioning from the “fee-for service” to the “pay-for performance” model. With this paradigm shift, the providers and payers are constantly thriving to determine tools to provide cost-effective and high quality of patient-care. Therefore, it is vital to account for the complications and its effect on the cost and quality of life. We set forth to determine the cost-utility associated with complications after lumbar spine surgery
Methods: Total 407 patients undergoing elective surgery for degenerative lumbar pathology enrolled into prospective longitudinal registry were included in the study. PROs:ODI, numeric rating scale-Back and leg pain(BP,LP), general health(SF-12) and quality of life scores EQ-5D were recorded at baseline, and 2-year after surgery. Two-year back-related medical resource utilization, missed work, and health state values (quality-adjusted life years[QALYs], calculated from the EQ-5D with US valuation using time weighted area under the curve approach) were assessed. Mean 2-year cost per QALY gained after surgery was assessed. The patients were divided into groups with and without complications to compare the QALYs gained and the cost-utility in these groups
Results: Fourteen percent(n=58) of patients developed complications within 90-days after surgery. Most frequent surgical complication was surgical site infection(4.2%,n=17),1.5%(n=6) had deep SSI. There was a significant improvement in pain(BP,LP), disability(ODI) and general health scores(EQ-5D and SF-12) in both groups at postoperative 2-year(P<0.0001).Patients with complications had lower mean cumulative 2-year QALY gained compared to those without complications(0.49 vs.0.57,p=0.36). Cost-per-QALYs gained in patients with and without complication was $70,822 vs $45,831(P=0.03).
Conclusions: Lumbar surgery provided a significant improvement in outcomes and gain in health state utility regardless of occurrence of complications within 90-days global period. The cost-utility was higher in patients with complications was $70,822, which is within the range of commonly accepted threshold of willingness to pay. Clearly, measures focused on prevention of complications reduce the cost and increase cost-utility.
Patient Care: We demonstrate that the complications is associated with lower cost-utlity compared to patients without complications. From hospital and providers perspective the measured focus on reducing complications and readmission might be able to reduce the cost associated with lumbar spine surgery. Interestingly, the patient-reported outcomes at postoperative 2-years was similar in patients with and without complications. The spine care providers can utilize this information to counsel patients that complication can cause frustration, inconvenience for patients and family and results lower cost-utility, however it does not appear to effect the long-term outcomes following surgery.
Learning Objectives: The occurrence of complication creates frustration, inconvenience for patients, providers and administrators. Furthermore, it results in lower cost-utility, however, the patient with complications achieve improvement similar to those without complication at postoperative 2-years.