COST-EFFECTIVENESS OF LUMBAR DISKECTOMY

Cost effectiveness analysis is useful when attempting to determine whe ther the benefits of an intervention are worth its costs. It can help clinicians to consider more explicitly all potential costs and outcome s of a given treatment, and it can assist policy makers in determining how best to allocate limited health-care resources to maximize the he alth of a population. This article describes the research methods used to estimate cost-effectiveness, and then examines existing reports on the cost-effectiveness of lumbar disc surgery. Results of previously published studies were inconsistent, indicating that estimates of disc ectomy's cost-effectiveness are highly dependent on how one measures a nd values the improvement in quality of life resulting from the proced ure. If only long-term outcomes are considered, the procedure appears no more effective than continued medical treatment. But discectomy see ms effective when its short-term benefits are considered. In either ca se, costs for the procedure are moderate. The authors conclude that fo r carefully selected patients with herniated lumbar discs, short-term quality of life is improved substantially with surgical versus medical treatment. When this benefit is considered, discectomy appears to be a cost-effective intervention, although this conclusion applies only t o carefully selected patients with clearly defined indications for sur gery. For patients without these indications and for patients in whom the immediate relief of sciatica is less important, discectomy's cost- effectiveness with be less favorable.