Cost-utility analysis of treatment methods in spinal diseases

AIM: The purpose of the present research study is to evaluate the quality of life of patients with musculoskeletal problems of the Spinal Column before and after surgery with the use of the EQ-5D-5L health status questionnaire. MATERIALS - METHODS: The research is based on primary data collection of 27 patients who completed the questionnaires at three different times: a) preoperatively; that is, after completion of conservative treatment which involved medication, physiotherapy, etc., b) ten days postoperatively and c) immediately after the first post-operative month. RESULTS: Out of the 27 patients, aged between 34 and 79 years (mean age 52±15,07) who participated in this study, 11 were males (40,7%) while 16 were females (59,3%). 48,1% of the patients suffered from a herniated intervertebral disc in the lumbar region, 18,5% from symptomatic degenerative disc disease (DDD or black disc), 18,5% from a herniated intervertebral disc in the cervical region and the remaining 14,8% from spondylolisthesis in the lumbar region. Total improvement of the quality of life (QoL) in our study was on average 0,6 QALYs at 10 days and 0,83 QALYs at 30 days. The total average direct cost of these surgical interventions amounted to 7413,1±3062,9 while the index of cost-utility for the sample population was estimated to be 12355,2 euro/ QALY at 10 days. This index decreased considerably to 8931,4 euro/ QALY at 30 days after the surgical intervention since the average benefit in QALYs increased and the QoL improved. CONCLUSIONS: The results of the present study point out the great utility of surgical interventions in the spinal column to treat patients’ common symptoms (low back pain with or without sciatica) with complications being nearly next to zero. By means of the EQ-5D-5L health status questionnaire, the comparative study of patients’ QoL both before and after surgical treatment reveals statistically considerable improvement at 10 and 30 days following the surgery. Finally, this study has led to useful conclusions: a) the modern technique of discoplasty is rather more efficient than percutaneous spinal fusion for the treatment of lumbago from degenerative disc disease in the lumbar region, b) conservative treatment of spinal column problems is rather less efficient than surgical treatment and c) modern surgery of the spinal column in Greece is rather more efficient than in other modern Health Systems.