Cost-effectiveness of conservative versus surgical treatment strategies of lumbar spinal stenosis in the Swiss setting: analysis of the prospective multicenter Lumbar Stenosis Outcome Study (LSOS).
PURPOSE
To evaluate the cost-effectiveness of conservative versus surgical treatment strategies for lumbar spinal stenosis (LSS).


METHODS
Patients prospectively enrolled in the multicenter Lumbar Stenosis Outcome Study (LSOS) with a minimum follow-up of 12 months were included. Quality adjusted life years (QALY) were calculated based on EQ-5D data. Cost data were retrieved retrospectively. Cost-effectiveness was calculated via decision tree analysis.


RESULTS
A total of 434 patients were included, treated surgically (n = 170) or conservatively (n = 264) for LSS. The majority of surgically treated patients underwent decompression (n = 141, 82.9%), and 17.1% (n = 29) additionally underwent fusion. A reoperation was required in 13 (7.6%) surgically treated patients. In 27 (10.2%) conservatively treated patients, a single infiltration was successful, with no further infiltration or surgery within the follow-up. However, 46 patients (17.4%) required multiple infiltrations, and in 191 (72.4%) initially conservatively treated patients a subsequent surgery was needed. The area under the curve was 0.776 QALY in the surgical arm (0.776 and 0.790, decompression or additional fusion, respectively), compared to 0.778 in the conservative arm. Treatment costs were estimated at CHF 12,958 and 13,637 (USD 13,465 and 14,169) in surgically and initially conservatively treated patients, respectively [base-case incremental cost-effectiveness ratio (ICER): CHF 392,145, USD 407,831], per QALY gained. Probabilistic sensitivity analysis identified surgery as the preferred strategy in 67.1%.


CONCLUSIONS
Both the surgical and the conservative treatment approach resulted in a comparable health-related quality of life within the first year after study inclusion. Due to slightly higher costs, mostly because the majority of initially conservatively treated patients underwent multiple infiltrations or a subsequent surgery, decompressive surgery was identified as the most cost-effective approach for LSS in this setting.
['Aichmair|A|A|', 'Burgstaller|J M|JM|', 'Schwenkglenks|M|M|', 'Steurer|J|J|', 'Porchet|F|F|', 'Brunner|F|F|', 'Farshad|M|M|', '|||']
D000368:Aged D000369:Aged, 80 and over D000072700:Conservative Treatment D003362:Cost-Benefit Analysis D003663:Decision Trees D019299:Decompression, Surgical D005260:Female D006801:Humans D008159:Lumbar Vertebrae D008297:Male D008875:Middle Aged D011446:Prospective Studies D011788:Quality of Life D019057:Quality-Adjusted Life Years D012086:Reoperation D013123:Spinal Fusion D013130:Spinal Stenosis D013557:Switzerland
Cost-effectiveness Conservative Surgical Lumbar spinal stenosis QALY Decision tree Health-care economics