Purpose and background. To explore the cost-utility of implementing stratified care for low back pain (LBP) in general practice, compared with usual care, within patient risk subgroups (low, medium and high risk of persistent disabling pain determined by the STarT Back tool). Methods. Adopting a cost-utility framework alongside a prospective, sequential comparison of separate patient cohorts (922 patients in total) with six-month follow-up, the base case analysis estimated the incremental LBP-related healthcare cost per additional quality-adjusted life year (QALY) by risk subgroup. Uncertainty was explored with cost-utility planes and acceptability curves. Sensitivity analyses examined alternative approaches (a complete case analysis, the incorporation of non-LBP-related healthcare use and estimation of societal costs relating to work absence). Results. Stratified care was a dominant treatment strategy compared with usual care for patients at high risk, with mean healthcare
The demand for spinal surgery and its costs have
both risen over the past decade. In 2008 the aggregate hospital
bill for surgical care of all spinal procedures was reported to
be $33.9 billion. One key driver of rising costs is spinal implants.
In 2011 our institution implemented a cost containment programme
for spinal implants which was designed to reduce the prices of individual
spinal implants and to reduce the inter-surgeon variation in implant costs.
Between February 2012 and January 2013, our spinal surgeons performed
1493 spinal procedures using implants from eight different vendors.
By applying market analysis and implant cost data from the previous
year, we established references prices for each individual type
of spinal implant, regardless of vendor, who were required to meet
these unit prices. We found that despite the complexity of spinal
surgery and the initial reluctance of vendors to reduce prices,
significant savings were made to the medical centre. Cite this article: 2015; 97-B:1102–5.
Using the United States Nationwide Inpatient
Sample, we identified national trends in revision spinal fusion
along with a comprehensive comparison of comorbidities, inpatient
complications and surgical factors of revision spinal fusion compared
to primary spinal fusion. In 2009, there were 410 158 primary spinal fusion discharges
and 22 128 revision spinal fusion discharges. Between 2002 and 2009,
primary fusion increased at a higher rate compared with revision
fusion (56.4% In the multivariable logistic regression model for all spinal
fusions, depression (odds ratio (OR) 1.53, p <
0.001), psychotic
disorders (OR 1.49, p <
0.001), deficiency anaemias (OR 1.35,
p <
0.001) and smoking (OR 1.10, p = 0.006) had a greater chance
of occurrence in revision spinal fusion discharges than in primary
fusion discharges, adjusting for other variables. In terms of complications,
after adjusting for all significant comorbidities, this study found
that dural tears (OR 1.41; p <
0.001) and surgical site infections
(OR 3.40; p <
0.001) had a greater chance of occurrence in revision
spinal fusion discharges than in primary fusion discharges (p <
0.001). A p-value <
0.01 was considered significant in all final
analyses. Cite this article: