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Value-based Care in the Management of Spinal Disorders: A Systematic Review of Cost-utility Analysis

  • Symposium: Value Based Healthcare
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Spinal disorders are a major cause of disability and compromise in health-related quality of life. The direct and indirect costs of treating spinal disorders are estimated at more than $100 billion per year. With limited resources, the cost-utility of interventions is important for allocating resources.

Questions/purposes

We therefore performed a systematic review of the literature on cost-utility for nonoperative and operative interventions for treating spinal disorders.

Methods

We searched four databases for cost-utility analysis studies on low back pain management and identified 1004 items. The titles and abstracts of 752 were screened before selecting 27 studies for inclusion; full texts of these 27 studies were individually evaluated by five individuals.

Results

Studies of nonoperative treatments demonstrated greater value for graded activity over physical therapy and pain management; spinal manipulation over exercise; behavioral therapy and physiotherapy over advice; and acupuncture and exercise over usual general practitioner care. Circumferential fusion and femoral ring allograft had greater value than posterolateral fusion and titanium cage, respectively. The relative cost-utility of operative versus nonoperative interventions was variable with the most consistent evidence indicating superior value of operative care for treating spinal disorders involving nerve compression and instability.

Conclusion

The literature on cost-utility for treating spinal disorders is limited. Studies addressing cost-utility of nonoperative and operative management of low back pain encompass a broad spectrum of diagnoses and direct comparison of treatments based on cost-utility thresholds for comparative effectiveness is limited by diversity among disorders and methods to assess cost-utility. Future research will benefit from uniform methods and comparison of treatments in cohorts with well-defined pathology.

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Author information

Authors and Affiliations

  1. Washington University in St Louis School of Medicine, St Louis, MO, USA

    Santoshi S. Indrakanti BS

  2. University of Minnesota, Minneapolis, MN, USA

    David Polly MD

  3. University of California-San Francisco, 500 Parnassus Avenue MU320 W, San Francisco, CA, 94143-0728, USA

    Michael H. Weber MD, Steven K. Takemoto PhD, Serena S. Hu MD & Sigurd H. Berven MD

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  1. Santoshi S. Indrakanti BS
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  2. Michael H. Weber MD
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  3. Steven K. Takemoto PhD
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  4. Serena S. Hu MD
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  6. Sigurd H. Berven MD
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Correspondence to Sigurd H. Berven MD.

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Each author certifies that he or she, or a member of their immediate family, has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

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Indrakanti, S.S., Weber, M.H., Takemoto, S.K. et al. Value-based Care in the Management of Spinal Disorders: A Systematic Review of Cost-utility Analysis. Clin Orthop Relat Res 470, 1106–1123 (2012). https://doi.org/10.1007/s11999-011-2141-2

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  • DOI: https://doi.org/10.1007/s11999-011-2141-2

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