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The 2‐Year Cost‐Effectiveness of 3 options to Treat Lumbar Spinal Stenosis Patients
Author(s) -
Udeh Belinda L.,
Costandi Shrif,
Dalton Jarrod E.,
Ghosh Raktim,
Yousef Hani,
Mekhail Nagy
Publication year - 2015
Publication title -
pain practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.899
H-Index - 58
eISSN - 1533-2500
pISSN - 1530-7085
DOI - 10.1111/papr.12160
Subject(s) - medicine , lumbar spinal stenosis , spinal stenosis , lumbar , stenosis , physical therapy , surgery , radiology
Abstract Lumbar spinal stenosis ( LSS ) may result from degenerative changes of the spine, which lead to neural ischemia, neurogenic claudication, and a significant decrease in quality of life. Treatments for LSS range from conservative management including epidural steroid injections ( ESI ) to laminectomy surgery. Treatments vary greatly in cost and success. ESI is the least costly treatment may be successful for early stages of LSS but often must be repeated frequently. Laminectomy surgery is more costly and has higher complication rates. Minimally invasive lumbar decompression ( mild ® ) is an alternative. Using a decision‐analytic model from the Medicare perspective, a cost‐effectiveness analysis was performed comparing mild ® to ESI or laminectomy surgery. The analysis population included patients with LSS who have moderate to severe symptoms and have failed conservative therapy. Costs included initial procedure, complications, and repeat/revision or alternate procedure after failure. Effects measured as change in quality‐adjusted life years ( QALY ) from preprocedure to 2 years postprocedure. Incremental cost‐effectiveness ratios were determined, and sensitivity analysis conducted. The mild ® strategy appears to be the most cost‐effective ($43,760/ QALY ), with ESI the next best alternative at an additional $37,758/ QALY . Laminectomy surgery was the least cost‐effective ($125,985/ QALY ).