Cost-Effectiveness of Surgical Versus Conservative Treatment for Thoracolumbar Burst Fractures. Issue 4 (February 2016)

• Record Type: Journal Article
• Authors: Aras, Efe Levent; Bunger, Cody; Hansen, Ebbe Stender; Søgaard, Rikke
• Is Part Of: Spine. Volume 41:Issue 4(2016)
• Publication Date: 2016-02
• Subjects: conservative treatment -- cost-effectiveness -- health economy analysis -- surgery -- thoracolumbar burst fracture; Spine -- Abnormalities -- Periodicals; Spine -- Diseases -- Periodicals; Spine -- Surgery -- Periodicals; 616.73005
• DOI: 10.1097/BRS.0000000000001219
• Languages: English
• ISSNs: 0362-2436

Abstract

Abstract : Study Design: Historical, register-based cohort study following 85 patients in the course of a time frame extending from 2 years before to 2 years after trauma occurrence. Objective: To investigate the cost-effectiveness of surgery versus conservative management for thoracolumbar burst fractures. Summary of Background Data: Despite the prevalence of thoracolumbar burst fractures, consensus has still not been reached in terms of their clinical management and whereas from a health policy point of view, efficient use of resources is equally important, literature pertaining to this aspect is limited. Methods: Consecutive patients who were admitted to a university clinic between 2004 and 2008 because of CT-verified AO type A3 fractures (T11-L2), age 18 to 65 years Patients with neurological compromise, osteoporosis, or malignancy were not included. The cost parameter defined primary and secondary health-care use (2010 [Euro sign]) and the effect parameter was based on three alternative measures of pain medication: morphine milligram and defined daily doses (DDD) of narcotic and nonnarcotic analgesics. For cost-effectiveness analysis, we employed a difference-in-difference approach, including control for treatment selection (age, sex, and fracture type). Nonparametric bootstrapping was used to estimate conventional 95% confidence intervals of mean estimates. Results: When taking into consideration all health-care consumption, surgical management was observed to cost an additional [Euro sign]10, 734 (4215; 15, 144) as compared with conservative management. The differences on morphine at 527(–3031; 6, 016) milligram, narcotic analgesics at –8(–176; 127) DDD, and nonnarcotic analgesics at –3(–72; 58) DDD were all insignificant The probability for surgery being cost-effective did not exceed 50% for any value of willingness to pay for effect. Conclusion: Surgical management does not seem to be a cost-effective strategy as compared with conservative management for traumatic thoracolumbar burst fractures without neurological deficits. In addition, higher-volume studies examining the clinical effect of alternative management strategies would be valuable. Level of Evidence: 3