Economic Evaluation of Lumbar Disc Herniation Surgery in Brazilian Health

Abstract

Introduction Lumbar discectomy is one of the most common surgical procedures, with success rates greater than 80%. To better understand the meaning of a good outcome in lumbar disc herniation treatment, it is important to know how much the health care system or the patient need to pay to achieve a good result. The cost–utility studies are useful to evaluate the value of health care interventions. The objective of this study was to evaluate for the first time the cost-effectiveness of spine surgery in Latin America for lumbar discectomy in terms of cost per quality-adjusted life years (QALY) gained in Brazil. Patients and Methods Costs of medical treatment were recorded in 143 consecutive patients who underwent open discectomy for lumbar disc herniation. Direct medical costs comprised medical reimbursement and costs of hospitalization. Indirect costs were considered the disability losses. Utilities were estimated using SF-6D–derived utilities from a 12-month variation in SF-36. A 4-year horizon with 3% discounting was applied to health utilities estimates. Sensitivity analysis was performed by varying utility gain by 20%. The costs were expressed in Reais (R$) and American Dollars ($), at an exchange rate of 2.4:1. Results Direct and indirect costs of open discectomy were estimated at an average of R$ 3.426,72 ($ 1,427.80) and R$ 2.027,67 ($ 844.86), respectively. The mean total cost of treatment was estimated at R$ 5.454,40 ($ 2,272.66) (± R$ 2.709,17/$ 1,128.82) The SF-6D utility gain was 0.0456 (95% CI: 0.03197–0.05923, p = 0.017) at 12 months. The 4-year discounted QALY gain was 0.176928. The estimated cost-utility ratio was R$ 30.828,35 ($ 12,845.14) per QALY gained. The sensitivity analysis showed a range of R$ 25.690,29 ($ 10,714.28)–R$ 38.535,44 ($ 16,056.43) per QALY gained. Conclusion Open discectomy is associated with a significant improvement in health utilities as measured by SF-6D. Open discectomy performed in the Brazilian Supplementary Health System provides a cost–utility ratio of R$ 30.828,35 ($ 12,845.14) per 1 quality-adjusted life year.