SF-36 PCS benefit-cost ratio of lumbar fusion comparison to other surgical interventions: A thought experiment

David W. Polly, Steven D. Glassman, James D. Schwender, Christopher I. Shaffrey, Charles Branch, J. Kenneth Burkus, Matthew F. Gornet, J. J. Abitbol, Sig Berven, Chris Bono, Rick Fessler, Kevin Foley, George Frey, Girard Girasole, Jeff Goldstein, Steve Heim, Jean Charles LeHuec, Hal Mathews, Russ Nockels, John PelozaMichael Rosner, Wolfgang Rauschning, Rick Sasso, Thomas Schuler, Paul Slosar, Brian Subach, Najeeb Thomas, Tom Zdeblick

Research output: Contribution to journalReview article

23 Citations (Scopus)

Abstract

STUDY DESIGN. A retrospective review of prospectively collected data. OBJECTIVES. To review systematically the SF-36 PCS outcomes of a large data set, including several randomized clinical trials for lumbar spine fusion at 1 and 2 years after surgery. We also present for comparison a review of typical changes in SF-36 PCS in other surgical interventions (total knee replacement, total hip replacement, and coronary artery bypass surgery) to define the average reimbursement costs per PCS improvement with each of these interventions. SUMMARY AND BACKGROUND DATA. Data from 11 prospective multicenter studies (9 Food and Drug Administration Investigational Device Exemption, Randomized Prospective Clinical Trials, class 1 data) accounted for the lumbar spine fusion group (n = 1826). Data for total knee replacement, total hip replacement, and coronary artery bypass surgery were obtained from a comprehensive review of the literature. METHODS. Comparisons of SF-36 PCS improvements were made at defined postoperative time points and with published study findings of other medical conditions. Reimbursement estimates (not including estimated physician and rehabilitation fees) for each surgical intervention were based on Centers for Medicare and Medicaid Services Medicare Provider Analysis and Review and All Payer Data (2002). Cost estimates were calculated for a minimal clinical important improvement (reimbursement dollars/mean PCS change *5.42 point PCS improvement). RESULTS. SF-36 PCS significantly improved at both 1 and 2 years following lumbar spine fusion surgery (P < 0.0001), and was comparable to the control surgical outcomes. With the use of data from Centers for Medicare and Medicaid Services Medicare Provider Analysis and Review and All Payer Data, hospital reimbursement averaged $15.2-18.2K for lumbar spine fusion, $9.8-11.3K for total knee replacement, $9.6-11.3K for total hip replacement, and $9.8-11.3K for coronary artery bypass surgery. Calculations of reimbursement dollars to elicit minimum clinically important change in PCS of 5.42 points following surgery ranged from $6.1 to $7.3K for lumbar spine fusion, $5.7 to $6.6K for total knee arthroplasty, $3.9 to $4.5K for total hip replacement, and $18.2 to $22.5K for coronary artery bypass surgery. CONCLUSION. While the exact numbers may vary for each treatment based on the population studied and the cost estimates used, lumbar fusion cost per benefit achieved was very comparable to other well-accepted medical interventions (total hip replacement, total knee replacement, and coronary artery bypass surgery).

Original languageEnglish (US)
JournalSpine
Volume32
Issue number11 SUPPL.
DOIs
StatePublished - May 1 2007
Externally publishedYes

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Knee Replacement Arthroplasties
Hip Replacement Arthroplasties
Coronary Artery Bypass
Cost-Benefit Analysis
Spine
Centers for Medicare and Medicaid Services (U.S.)
Medicare
Costs and Cost Analysis
Randomized Controlled Trials
Fees and Charges
United States Food and Drug Administration
Multicenter Studies
Rehabilitation
Prospective Studies
Physicians
Equipment and Supplies
Population

All Science Journal Classification (ASJC) codes

  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

Polly, D. W., Glassman, S. D., Schwender, J. D., Shaffrey, C. I., Branch, C., Burkus, J. K., ... Zdeblick, T. (2007). SF-36 PCS benefit-cost ratio of lumbar fusion comparison to other surgical interventions: A thought experiment. Spine, 32(11 SUPPL.). https://doi.org/10.1097/BRS.0b013e318053d4e5

SF-36 PCS benefit-cost ratio of lumbar fusion comparison to other surgical interventions : A thought experiment. / Polly, David W.; Glassman, Steven D.; Schwender, James D.; Shaffrey, Christopher I.; Branch, Charles; Burkus, J. Kenneth; Gornet, Matthew F.; Abitbol, J. J.; Berven, Sig; Bono, Chris; Fessler, Rick; Foley, Kevin; Frey, George; Girasole, Girard; Goldstein, Jeff; Heim, Steve; LeHuec, Jean Charles; Mathews, Hal; Nockels, Russ; Peloza, John; Rosner, Michael; Rauschning, Wolfgang; Sasso, Rick; Schuler, Thomas; Slosar, Paul; Subach, Brian; Thomas, Najeeb; Zdeblick, Tom.

In: Spine, Vol. 32, No. 11 SUPPL., 01.05.2007.

Research output: Contribution to journalReview article

Polly, DW, Glassman, SD, Schwender, JD, Shaffrey, CI, Branch, C, Burkus, JK, Gornet, MF, Abitbol, JJ, Berven, S, Bono, C, Fessler, R, Foley, K, Frey, G, Girasole, G, Goldstein, J, Heim, S, LeHuec, JC, Mathews, H, Nockels, R, Peloza, J, Rosner, M, Rauschning, W, Sasso, R, Schuler, T, Slosar, P, Subach, B, Thomas, N & Zdeblick, T 2007, 'SF-36 PCS benefit-cost ratio of lumbar fusion comparison to other surgical interventions: A thought experiment', Spine, vol. 32, no. 11 SUPPL.. https://doi.org/10.1097/BRS.0b013e318053d4e5
Polly DW, Glassman SD, Schwender JD, Shaffrey CI, Branch C, Burkus JK et al. SF-36 PCS benefit-cost ratio of lumbar fusion comparison to other surgical interventions: A thought experiment. Spine. 2007 May 1;32(11 SUPPL.). https://doi.org/10.1097/BRS.0b013e318053d4e5
Polly, David W. ; Glassman, Steven D. ; Schwender, James D. ; Shaffrey, Christopher I. ; Branch, Charles ; Burkus, J. Kenneth ; Gornet, Matthew F. ; Abitbol, J. J. ; Berven, Sig ; Bono, Chris ; Fessler, Rick ; Foley, Kevin ; Frey, George ; Girasole, Girard ; Goldstein, Jeff ; Heim, Steve ; LeHuec, Jean Charles ; Mathews, Hal ; Nockels, Russ ; Peloza, John ; Rosner, Michael ; Rauschning, Wolfgang ; Sasso, Rick ; Schuler, Thomas ; Slosar, Paul ; Subach, Brian ; Thomas, Najeeb ; Zdeblick, Tom. / SF-36 PCS benefit-cost ratio of lumbar fusion comparison to other surgical interventions : A thought experiment. In: Spine. 2007 ; Vol. 32, No. 11 SUPPL.
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abstract = "STUDY DESIGN. A retrospective review of prospectively collected data. OBJECTIVES. To review systematically the SF-36 PCS outcomes of a large data set, including several randomized clinical trials for lumbar spine fusion at 1 and 2 years after surgery. We also present for comparison a review of typical changes in SF-36 PCS in other surgical interventions (total knee replacement, total hip replacement, and coronary artery bypass surgery) to define the average reimbursement costs per PCS improvement with each of these interventions. SUMMARY AND BACKGROUND DATA. Data from 11 prospective multicenter studies (9 Food and Drug Administration Investigational Device Exemption, Randomized Prospective Clinical Trials, class 1 data) accounted for the lumbar spine fusion group (n = 1826). Data for total knee replacement, total hip replacement, and coronary artery bypass surgery were obtained from a comprehensive review of the literature. METHODS. Comparisons of SF-36 PCS improvements were made at defined postoperative time points and with published study findings of other medical conditions. Reimbursement estimates (not including estimated physician and rehabilitation fees) for each surgical intervention were based on Centers for Medicare and Medicaid Services Medicare Provider Analysis and Review and All Payer Data (2002). Cost estimates were calculated for a minimal clinical important improvement (reimbursement dollars/mean PCS change *5.42 point PCS improvement). RESULTS. SF-36 PCS significantly improved at both 1 and 2 years following lumbar spine fusion surgery (P < 0.0001), and was comparable to the control surgical outcomes. With the use of data from Centers for Medicare and Medicaid Services Medicare Provider Analysis and Review and All Payer Data, hospital reimbursement averaged $15.2-18.2K for lumbar spine fusion, $9.8-11.3K for total knee replacement, $9.6-11.3K for total hip replacement, and $9.8-11.3K for coronary artery bypass surgery. Calculations of reimbursement dollars to elicit minimum clinically important change in PCS of 5.42 points following surgery ranged from $6.1 to $7.3K for lumbar spine fusion, $5.7 to $6.6K for total knee arthroplasty, $3.9 to $4.5K for total hip replacement, and $18.2 to $22.5K for coronary artery bypass surgery. CONCLUSION. While the exact numbers may vary for each treatment based on the population studied and the cost estimates used, lumbar fusion cost per benefit achieved was very comparable to other well-accepted medical interventions (total hip replacement, total knee replacement, and coronary artery bypass surgery).",
author = "Polly, {David W.} and Glassman, {Steven D.} and Schwender, {James D.} and Shaffrey, {Christopher I.} and Charles Branch and Burkus, {J. Kenneth} and Gornet, {Matthew F.} and Abitbol, {J. J.} and Sig Berven and Chris Bono and Rick Fessler and Kevin Foley and George Frey and Girard Girasole and Jeff Goldstein and Steve Heim and LeHuec, {Jean Charles} and Hal Mathews and Russ Nockels and John Peloza and Michael Rosner and Wolfgang Rauschning and Rick Sasso and Thomas Schuler and Paul Slosar and Brian Subach and Najeeb Thomas and Tom Zdeblick",
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T1 - SF-36 PCS benefit-cost ratio of lumbar fusion comparison to other surgical interventions

T2 - A thought experiment

AU - Polly, David W.

AU - Glassman, Steven D.

AU - Schwender, James D.

AU - Shaffrey, Christopher I.

AU - Branch, Charles

AU - Burkus, J. Kenneth

AU - Gornet, Matthew F.

AU - Abitbol, J. J.

AU - Berven, Sig

AU - Bono, Chris

AU - Fessler, Rick

AU - Foley, Kevin

AU - Frey, George

AU - Girasole, Girard

AU - Goldstein, Jeff

AU - Heim, Steve

AU - LeHuec, Jean Charles

AU - Mathews, Hal

AU - Nockels, Russ

AU - Peloza, John

AU - Rosner, Michael

AU - Rauschning, Wolfgang

AU - Sasso, Rick

AU - Schuler, Thomas

AU - Slosar, Paul

AU - Subach, Brian

AU - Thomas, Najeeb

AU - Zdeblick, Tom

PY - 2007/5/1

Y1 - 2007/5/1

N2 - STUDY DESIGN. A retrospective review of prospectively collected data. OBJECTIVES. To review systematically the SF-36 PCS outcomes of a large data set, including several randomized clinical trials for lumbar spine fusion at 1 and 2 years after surgery. We also present for comparison a review of typical changes in SF-36 PCS in other surgical interventions (total knee replacement, total hip replacement, and coronary artery bypass surgery) to define the average reimbursement costs per PCS improvement with each of these interventions. SUMMARY AND BACKGROUND DATA. Data from 11 prospective multicenter studies (9 Food and Drug Administration Investigational Device Exemption, Randomized Prospective Clinical Trials, class 1 data) accounted for the lumbar spine fusion group (n = 1826). Data for total knee replacement, total hip replacement, and coronary artery bypass surgery were obtained from a comprehensive review of the literature. METHODS. Comparisons of SF-36 PCS improvements were made at defined postoperative time points and with published study findings of other medical conditions. Reimbursement estimates (not including estimated physician and rehabilitation fees) for each surgical intervention were based on Centers for Medicare and Medicaid Services Medicare Provider Analysis and Review and All Payer Data (2002). Cost estimates were calculated for a minimal clinical important improvement (reimbursement dollars/mean PCS change *5.42 point PCS improvement). RESULTS. SF-36 PCS significantly improved at both 1 and 2 years following lumbar spine fusion surgery (P < 0.0001), and was comparable to the control surgical outcomes. With the use of data from Centers for Medicare and Medicaid Services Medicare Provider Analysis and Review and All Payer Data, hospital reimbursement averaged $15.2-18.2K for lumbar spine fusion, $9.8-11.3K for total knee replacement, $9.6-11.3K for total hip replacement, and $9.8-11.3K for coronary artery bypass surgery. Calculations of reimbursement dollars to elicit minimum clinically important change in PCS of 5.42 points following surgery ranged from $6.1 to $7.3K for lumbar spine fusion, $5.7 to $6.6K for total knee arthroplasty, $3.9 to $4.5K for total hip replacement, and $18.2 to $22.5K for coronary artery bypass surgery. CONCLUSION. While the exact numbers may vary for each treatment based on the population studied and the cost estimates used, lumbar fusion cost per benefit achieved was very comparable to other well-accepted medical interventions (total hip replacement, total knee replacement, and coronary artery bypass surgery).

AB - STUDY DESIGN. A retrospective review of prospectively collected data. OBJECTIVES. To review systematically the SF-36 PCS outcomes of a large data set, including several randomized clinical trials for lumbar spine fusion at 1 and 2 years after surgery. We also present for comparison a review of typical changes in SF-36 PCS in other surgical interventions (total knee replacement, total hip replacement, and coronary artery bypass surgery) to define the average reimbursement costs per PCS improvement with each of these interventions. SUMMARY AND BACKGROUND DATA. Data from 11 prospective multicenter studies (9 Food and Drug Administration Investigational Device Exemption, Randomized Prospective Clinical Trials, class 1 data) accounted for the lumbar spine fusion group (n = 1826). Data for total knee replacement, total hip replacement, and coronary artery bypass surgery were obtained from a comprehensive review of the literature. METHODS. Comparisons of SF-36 PCS improvements were made at defined postoperative time points and with published study findings of other medical conditions. Reimbursement estimates (not including estimated physician and rehabilitation fees) for each surgical intervention were based on Centers for Medicare and Medicaid Services Medicare Provider Analysis and Review and All Payer Data (2002). Cost estimates were calculated for a minimal clinical important improvement (reimbursement dollars/mean PCS change *5.42 point PCS improvement). RESULTS. SF-36 PCS significantly improved at both 1 and 2 years following lumbar spine fusion surgery (P < 0.0001), and was comparable to the control surgical outcomes. With the use of data from Centers for Medicare and Medicaid Services Medicare Provider Analysis and Review and All Payer Data, hospital reimbursement averaged $15.2-18.2K for lumbar spine fusion, $9.8-11.3K for total knee replacement, $9.6-11.3K for total hip replacement, and $9.8-11.3K for coronary artery bypass surgery. Calculations of reimbursement dollars to elicit minimum clinically important change in PCS of 5.42 points following surgery ranged from $6.1 to $7.3K for lumbar spine fusion, $5.7 to $6.6K for total knee arthroplasty, $3.9 to $4.5K for total hip replacement, and $18.2 to $22.5K for coronary artery bypass surgery. CONCLUSION. While the exact numbers may vary for each treatment based on the population studied and the cost estimates used, lumbar fusion cost per benefit achieved was very comparable to other well-accepted medical interventions (total hip replacement, total knee replacement, and coronary artery bypass surgery).

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