Abstract
BackgroundMicrodiscectomy is the most commonly performed spine surgery and the first transitioning for outpatient settings. However, this transition was never studied, in what comes to cost-utility assessment. Accordingly, this economic study aims to access the cost-effectiveness of outpatient lumbar microdiscectomy when compared with the inpatient procedure.MethodsThis is a cost utility study, adopting the hospital perspective. Direct medical costs were retrieved from the assessment of 20 patients undergoing outpatient lumbar microdiscectomy and 20 undergoing inpatient lumbar microdiscectomy Quality-adjusted life-years were calculated from Oswestry Disability Index values (ODI). ODI was prospectively assessed in outpatients in pre and 3- and 6-month post-operative evaluations. Inpatient ODI data were estimated from a meta-analysis. A probabilistic sensitivity analysis was performed and incremental cost-effectiveness ratio (ICER) calculated.ResultsOutpatient procedure was cost-saving in all models tested. At 3-month assessment ICER ranged from €135,753 to €345,755/QALY, higher than the predefined threshold of €60,000/QALY gained. At 6-month costs were lower and utilities were higher in outpatient, overpowering the inpatient procedure. Probabilistic sensitivity analysis showed that in 65% to 73% of simulations outpatient was the better option. The savings with outpatient were about 55% of inpatient values, with similar utility scores. No 30-day readmissions were recorded in either group.ConclusionThis is the first economic study on cost-effectiveness of outpatient lumbar microdiscectomy, showing a significant reduction in costs, with a similar clinical outcome, proving it cost-effective.
Highlights
Microdiscectomy is the most commonly performed spine surgery and the first transitioning for outpa‐ tient settings
Costs data Costs were retrieved from 20 outpatients and 20 inpatients submitted to lumbar MD, in whom no significant differences were found for any assessed sociodemographic characteristics (Table 1)
No loss of follow-up was observed in the six-month assessment period for the outpatients (Table 1)
Summary
This is a cost utility study, adopting the hospital perspective. Direct medical costs were retrieved from the assessment of 20 patients undergoing outpatient lumbar microdiscectomy and 20 undergoing inpatient lumbar microdiscectomy Quality-adjusted life-years were calculated from Oswestry Disability Index values (ODI). A probabilistic sensitivity analysis was performed and incremental cost-effectiveness ratio (ICER) calculated. Study design This is a cost-utility study, corresponding to a full economic evaluation comparing both costs and effectivity in patients undergoing MD in the outpatient versus in the inpatient setting in a Portuguese National Healthcare System hospital. Specific data from 20 outpatients and 20 inpatients undergoing MD with single excision of herniated intervertebral disk was gathered. Patients were excluded if they presented: (1) comorbidities precluding outpatient surgery; (2) social conditions precluding outpatient surgery (i.e. living alone or far from the hospital, psychiatric conditions); (3) need for additional spine surgical procedures other than single excision of herniated intervertebral disk; or (4) previous lumbar spine surgery. All patients were submitted to a lumbar MD by the same surgical team
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