Societal Cost Patterns By Spine Surgical Outcome Groups And Patients Treated With Spinal Cord Stimulation Following Spine Surgery

Abstract

To identify patients with different outcomes of lumbar spine surgery in terms of pain relief and patients who are subsequently treated with spinal cord stimulation (SCS) and describe the patterns of societal costs and quality of life (QoL) in these groups. Patients who underwent elective lumbar spine surgery during 2000–2012 were identified in the Swedish spine register Swespine (n=7,227). Patients with persistent pain and subsequently treated with SCS (“to-be SCS patients”) were identified in the Swedish national patient register (n=236). Outcomes of spine surgery were defined using Global Assessment (GA) of back/leg pain reported 2 years post-surgery. GA level 1 (pain disappeared) and 2 (much improved) were categorised as “successful”; 3 (somewhat improved) as “undetermined”; 4 (unchanged) and 5 (worsened) as “persistent pain”. To-be SCS patients were not analysed by GA-level. Costs (healthcare resources and indirect costs) were calculated 3 years before/after surgery, for each outcome group and to-be SCS patients. QoL was estimated using EQ-5D reported at baseline and year 5 post-surgery. Most patients had successful outcome (73%). In all groups, costs increased gradually leading up to surgery and peaked in the month after surgery. Three years pre-surgery, mean monthly total cost was in the successful group: €531; undetermined: €882; persistent pain: €891; and to-be SCS patients: €1,153. Three years post-surgery, the corresponding cost was €509, €1,105, €1,269 and €3,346, respectively. The groups with persistent pain, undetermined outcome and to-be SCS patients had worse baseline QoL (0.26, 0.33, 0.20, respectively) and worse QoL post-surgery (0.46, 0.62, 0.24), compared with the successful group (baseline: 0.34, post-surgery 0.82). There was an apparent association between outcome, costs and post-surgery QoL. Patients with undetermined outcome, persistent pain and to-be-SCS patients had less QoL improvement post-surgery and higher costs both before and after surgery compared with the successful group.