Cost effectiveness of lumbar disc surgery and of a preventive treatment for peridural fibrosis

Abstract

Study design: This study used a retrospective modeling approach to predict the sequelae, treatment patterns, and economic outcomes that patients treated or not treated with ADCON^®-L Anti-Adhesion Barrier Gel can experience over a 1-year period following first-time surgery for herniated lumbar disc. The study was designed for and carried out in the Netherlands. Objectives: The study was carried out to investigate the economic impact of ADCON-L application in lumbar disc surgery. Summary of background data: Patients with a poor outcome following primary lumbar disc surgery represent a medical challenge to physicians and an economic concern, as they often experience long-term sequelae. Patients who have failed to benefit adequately from primary surgery tend to be very expensive patients, receiving a costly array of conservative therapies, diagnostic measures and, sometimes, repeat surgery. Methods: A Markov model was constructed to integrate the retrospectively assessed treatment patterns, economic outcomes, and costs of Dutch lumbar disc patients with the analysis of the benefits of ADCON-L as shown in a clinical study population derived from the preliminary results of a multicenter, randomized clinical trial of ADCON-L in Europe. Results: Use of ADCON-L can recoup 20% of its proposed initial cost of NLG 1000 in direct health care savings during the first year after primary surgery. When indirect/societal as well as direct costs are considered, for every Dutch guilder invested in ADCON-L treatment, savings of NLG 1.8 are achieved. Conclusions: In patients treated with ADCON-L during lumbar discectomy, the quality of surgical outcome improves while cost per successful outcome is reduced.