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Patient Outcomes/Effectiveness Research

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Surgical discectomy is cost effective for certain patients with herniated discs

Lumbar discectomy for carefully selected patients who have herniated discs and do not respond to nonsurgical care provides substantial benefit and is reasonably cost effective, according to a cost-effectiveness analysis by the Back Pain Patient Outcomes Research Team (PORT). The cost effectiveness of discectomy (surgical removal of a disc) is $29,200 to $33,900 per quality-adjusted year of life gained and may be as low as $12,000. This compares very favorably with other widely used therapies, such as coronary artery bypass grafting for heart disease and medical therapy for moderate hypertension. Discectomy also increases average quality-adjusted life expectancy by nearly half a year.

This finding of cost-effectiveness may aid physicians and patients, who often find it difficult to decide whether surgery for a herniated disc is worth the risks and costs. This procedure can relieve pain more rapidly for those who fail to respond to medical management. But it is $10,000 more than the cost for continued medical treatment, and the advantage may be only temporary. Patients undergoing the surgery sometimes find that they have the same level of low back pain 4 or 10 years later as those who had no surgery for this often self-limiting condition.

Led by Richard A. Deyo, M.D., M.P.H., of the University of Washington, and supported by the Agency for Health Care Policy and Research (HS06344), the research team used existing efficacy data of a published trial of 126 herniated disc patients randomized to surgical or nonsurgical treatment, as well as newly gathered cost data. They calculated cost-effectiveness in dollars per quality-adjusted year of life gained. Patients in the trials had undergone 2-6 weeks of medical treatment and were still experiencing pain, had herniated discs on myelogram (spinal x-ray with contrast medium in the spinal canal), and usually showed abnormal neurologic findings on physical exam.

More details are in "Cost-effectiveness of lumbar discectomy for the treatment of herniated vertebral disc," by Alex D. Malter, M.D., M.P.H., Eric B. Larson, M.D., M.P.H., Nicole Urban, Sc.D., and Dr. Deyo, in Spine 21(9), pp. 1048-1055, 1996.

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