General Session: Value and Outcomes in Spine Surgery - Hall F

Presented by: B. Rischke


B. Rischke(1), E. Rischke(1), J.Y. Lazennec(2)

(1) Spine-Center-Rischke, Spine Surgery, Zurich, Switzerland
(2) University PMC, Paris, Orthopaedic and Trauma Surgery, Pitié-Salpétrière Hospital Assistance Publique - Hopitaux de Paris, Paris, France


Purpose: The aim of this analysis was to examine the cost-utility effects of intervertebral disc prosthesis versus spondylodesis from the perspective of the health insurance system.

Material and Methods: The clinical data of the present analysis were obtained from a clinical prospective multicentre study on 83 (35m, 48f) patients with the viscoelastic total disc replacment-LP-ESP (VTDR) in unisegmental lumbar disc degeneration and from registry data from the Spine Tango registry for spondylodesis on 151 patients (58 m, 93 f) in ALIF-, PLIF- and 360 °-technology (fusion) in unisegmental lumbar disc degeneration. The quality of life according to the SF 36 M and SF 36 P scores was assessed preoperatively 3, 6, 12 and 24 months postoperatively. (Statistik: Wilcoxon- und Chi2-test, p-value). The utility assessment was based on the QALY concept. Using the SF-6D algorithm, the SF-36 data could be aggregated into the SF-6D Brazier Index (SF-6D) and thus transformed into the QALY calculation.

Results: The VTDR group improved significantly in SF 36 mentally from 42% pre-op to 62% after 2 years, in SF 36 physically from 27% pre-op to 58% after 2 years postoperatively in contrast to the spondylodesis group the SF 36 mentally improved from 29% pre-op to 43% after 2 years and in SF 36 physically from 29% pre-op to 37% after 2 years postoperatively (p < 0.0001). In the quality-adjusted-life-years (QALY´s) the VTDR group also gained significantly higher useful value of 0.829 QALY's after 2 years compared to the spondylodesis group (p < 0.0001). In the outpatient costs there could not be identified costs-differences in both study groups. The hospital expenses were calculated on the basis of the DRG proceeds. In Switzerland and Germany, therefore the costs of spondylodesis (I09 E = 7,950.74 € / 19.845.50 CHF) are higher than for a disc prosthesis (I45 B = 7.265.39 € / 13.870, - CHF). The quotient of costs (DRG revenue) and QALY´s were compared to determine the cost-utility value. There was a significant cost-benefit-effectiveness of the visco-elastic disc replacement (VTDR) with the LP-ESP in contrast to spondylodesis (PLIF, ALIF, 360 °).

Discussion: In a comparative analysis of the cost-utility of the lumbar visco-elastic total disc replacement versus various lumbar fusion techniques in unisegmental intervertebral disc regeneration, the viscoelastic intervertebral disc prosthesis demonstrated not only more cost saving for the health insurances in Germany and Switzerland than spondylodesis but also significantly more effective in improving health-related quality of life.