BMJ  2005;330:1239 (28 May), doi:10.1136/bmj.38441.429618.8F (published 23 May 2005)

Paper

Surgical stabilisation of the spine compared with a programme of intensive rehabilitation for the management of patients with chronic low back pain: cost utility analysis based on a randomised controlled trial

¹ Health Economics Research Centre, Department of Public Health, University of Oxford, Oxford OX3 7LF Oliver, ² Nuffield Orthopaedic Centre, Oxford OX3 7LD, ³ Division of Health in the Community, University of Warwick, Warwick CV4 7AL

Objective To determine whether, from a health provider and patient perspective, surgical stabilisation of the spine is cost effective when compared with an intensive programme of rehabilitation in patients with chronic low back pain.

Design Economic evaluation alongside a pragmatic randomised controlled trial.

Setting Secondary care.

Participants 349 patients randomised to surgery (n = 176) or to an intensive rehabilitation programme (n = 173) from 15 centres across the United Kingdom between June 1996 and February 2002.

Main outcome measures Costs related to back pain and incurred by the NHS and patients up to 24 months after randomisation. Return to paid employment and total hours worked. Patient utility as estimated by using the EuroQol EQ-5D questionnaire at several time points and used to calculate quality adjusted life years (QALYs). Cost effectiveness was expressed as an incremental cost per QALY.

Results At two years, 38 patients randomised to rehabilitation had received rehabilitation and surgery whereas just seven surgery patients had received both treatments. The mean total cost per patient was estimated to be £7830 (SD £5202) in the surgery group and £4526 (SD £4155) in the intensive rehabilitation arm, a significant difference of £3304 (95% confidence interval £2317 to £4291). Mean QALYs over the trial period were 1.004 (SD 0.405) in the surgery group and 0.936 (SD 0.431) in the intensive rehabilitation group, giving a non-significant difference of 0.068 (–0.020 to 0.156). The incremental cost effectiveness ratio was estimated to be £48 588 per QALY gained (–£279 883 to £372 406).

Conclusion Two year follow-up data show that surgical stabilisation of the spine may not be a cost effective use of scarce healthcare resources. However, sensitivity analyses show that this could change—for example, if the proportion of rehabilitation patients requiring subsequent surgery continues to increase.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Relevant Articles

... and intensive rehabilitation is cheaper
BMJ 2005 330: 0. [Full Text]

Surgery versus intensive rehabilitation programmes for chronic low back pain

Bart W Koes
BMJ 2005 330: 1220-1221. [Extract] [Full Text] [PDF]

Randomised controlled trial to compare surgical stabilisation of the lumbar spine with an intensive rehabilitation programme for patients with chronic low back pain: the MRC spine stabilisation trial

Jeremy Fairbank, Helen Frost, James Wilson-MacDonald, Ly-Mee Yu, Karen Barker, Rory Collins for the Spine Stabilisation Trial Group
BMJ 2005 330: 1233. [Abstract] [Full Text] [PDF]

National Institute for Clinical Excellence and its value judgments

Michael D Rawlins and Anthony J Culyer
BMJ 2004 329: 224-227. [Extract] [Full Text] [PDF]

Multicentre aneurysm screening study (MASS): cost effectiveness analysis of screening for abdominal aortic aneurysms based on four year results from randomised controlled trial

Multicentre Aneurysm Screening Study Group
BMJ 2002 325: 1135. [Abstract] [Full Text] [PDF]

This article has been cited by other articles:

• CHURCH, E. J., ODLE, T. G. (2007). Diagnosis and Treatment Of back Pain. radtech 79: 126-151 [Abstract] [Full text]  
• Yu, L.-M., Burton, A., Rivero-Arias, O. (2007). Evaluation of software for multiple imputation of semi-continuous data. Stat Methods Med Res 16: 243-258 [Abstract]  
• Groot Koerkamp, B., Hunink, M.G. M., Stijnen, T., Hammitt, J. K., Kuntz, K. M., Weinstein, M. C. (2007). Limitations of Acceptability Curves for Presenting Uncertainty in Cost-Effectiveness Analysis. Med Decis Making 27: 101-111 [Abstract]  
• Bridwell, K. H., Anderson, P. A., Boden, S. D., Vaccaro, A. R., Wang, J. C. (2006). What's New in Spine Surgery. JBJS 88: 1897-1907 [Full text]  
• Moffett, J., McLean, S. (2006). The role of physiotherapy in the management of non-specific back pain and neck pain. Rheumatology (Oxford) 45: 371-378 [Abstract] [Full text]  
• (2005). Spinal Fusion and Chronic Low Back Pain: Not the Best Match. JWatch General 2005: 7-7 [Full text]  

Rapid Responses:

Read all Rapid Responses

Surgical stabilisation of the spine trial may under-estimate treatment effect

Philip Sell
bmj.com, 2 Jun 2005 [Full text]