Economics

Top Papers are articles in a specific subject rated by professionals and scholars in the field. Top 10 articles are displayed in an order from the most highest rating to the lowest. In order to rate an article, one must first register at SpineDeformityBlog.com as a member.

Expenditures and Health Status Among Adults With Back and Neck Problems.

Martin BI, Deyo RA, Mirza SK, Turner JA, Comstock BA, Hollingworth W, Sullivan SD.

JAMA. 2008; 299: 656-664.

PMID: 18270354

This study used a large general-population survey to examine the changes in spine-related expenditures and health status from 1997 to 2005.  Expenditures for spine increased 65%, but significantly more spine respondents reported limitations.  This study provides the big picture that substantially increased spending on spine has not achieved better outcomes.

web:  http://jama.ama-assn.org/content/299/6/656.full.pdf

Posted by on Nov 16, 2011 in Economics | 0 comments

Surgical treatment of spinal stenosis with and without degenerative spondylolisthesis: cost-effectiveness after 2 years.

Tosteson AN, Lurie JD, Tosteson TD, et al.

Ann Intern Med.  2008; 149: 845-853.

PMID: 19075203

This SPORT report on cost-effectiveness found that, compared to non-operative treatment, decompression alone was cost-effective in 100% of stenosis samples and 92% of spondylolisthesis samples, while fusion was cost-effective in only 17% of stenosis samples and only 8% (18%?) of spondylolisthesis samples.  This paper has substantial implications for healthcare policy.

web:  http://www.annals.org/content/149/12/845.full.pdf

Posted by on Nov 16, 2011 in Economics | 0 comments

Prolonged conservative care versus early surgery in patients with sciatica from lumbar disc herniation: cost utility analysis alongside a randomised controlled trial.

van den Hout WB, Peul WC, Koes BW, Brand R, Kievit J, Thomeer RT; Leiden-The Hague Spine Intervention Prognostic Study Group.

BMJ. 2008; 336: 1351-1354.

PMID: 18502912

This cost-utility analysis is based on a high-quality RCT comparing early surgery to prolonged conservative care for sciatica.  Early surgery appears to be cost-effective, at least from the societal perspective, but there was wide statistical uncertainty.  This paper is an excellent model for cost-utility studies.

web:  http://www.bmj.com/content/336/7657/1351.full.pdf

Posted by on Nov 16, 2011 in Economics | 0 comments

Surgical stabilisation of the spine compared with a programme of intensive rehabilitation for the management of patients with chronic low back pain: cost utility analysis based on a randomised controlled trial.

Rivero-Arias O, Campbell H, Gray A, Fairbank J, Frost H, Wilson-MacDonald J.

BMJ.  2005; 330: 1239.

PMID: 15911536

This cost-utility analysis is based on a high-quality RCT comparing surgery to intensive rehabilitation for chronic low back pain.  Surgery was not cost-effective compared to intensive rehabilitation at two-year follow-up.  This paper provides important information for healthcare policy and treatment decision-making for patients with chronic low back pain.

web:  http://www.bmj.com/highwire/filestream/362013/field_highwire_article_pdf/0.pdf

Posted by on Nov 16, 2011 in Economics | 0 comments

Prevalence, Complications, and Hospital Charges Associated with Use of Bone-Morphogenetic Proteins in Spinal Fusion Procedures.

Cahill KS, Chi JH, Day A, Claus EB.

JAMA.  2009; 302: 58-66.

PMID: 1956744

This study looked at the use of BMP and resulting complications and costs in an incredibly large database of over 300,000 fusion patients!  BMP substantially increased cervical complications costs when used cervically or lumbarly.  This paper raises important questions about BMP use for the current era of economic contraction.

web:  http://jama.ama-assn.org/content/302/1/58.full.pdf

Posted by on Nov 16, 2011 in Economics | 0 comments

Increases in Lumbosacral Injections in the Medicare Population: 1994 to 2001.

Friedly J, Chan L, Deyo R.

Spine.  2007; 32: 1754-1760.

PMID: 17632396

This study examined the costs of lumbosacral steroid injections in a Medicare population sample with over 2 million beneficiaries.  Total inflation-adjusted physician fees for all lumbosacral injections increased from $24 million in 1994 to $175 million in 2001.  This paper raises serious questions about the growing use of injections.

web:  http://journals.lww.com/spinejournal/pages/articleviewer.aspx?year=2007&issue=07150&article=00010&type=abstract

Posted by on Nov 16, 2011 in Economics | 0 comments

The Cost Effectiveness of Surgical Versus Nonoperative Treatment for Lumbar Disc Herniation Over Two Years: Evidence from the Spine Patient Outcomes Research Trial (SPORT).

Tosteson AN, Skinner JS, Tosteson TD, et al.

Spine.  2008; 33: 2108-2115.

PMID: 18777603

This SPORT report analyzed the cost-effectiveness of surgery versus nonoperative care for disk herniation by 2 years.  Surgery had a cost per QALY gained of $69,000, thus making it cost-effective in the US system but possibly not elsewhere.  This is the definitive US cost-effectiveness study of surgery for disk herniation.

web:  http://journals.lww.com/spinejournal/pages/articleviewer.aspx?year=2008&issue=09010&article=00016&type=abstract

Posted by on Nov 16, 2011 in Economics | 0 comments

Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 3: assessment of economic outcome.

Resnick DK, Choudhri TF, Dailey AT, et al.

J Neurosurg Spine.  2005; 2: 647-652.

PMID: 16028731

This review paper from AANS/CNS summarizes 12 publications dealing with the hospital costs, return-to-work, or cost-benefits of lumbar fusion.  Although conclusions should not be drawn from this earlier body of literature, this review paper is a useful guide to the economic literature on fusion up to 2001.

web:  http://www.ncbi.nlm.nih.gov/pubmed/16028731

Posted by on Nov 16, 2011 in Economics | 0 comments

Intraoperative Waste in Spine Surgery: Incidence, Cost, and Effectiveness of an Educational Program.

Soroceanu A, Canacari E, Brown E, Robinson A, McGuire KJ.

Spine.  2011; 36: E1270-1273.

PMID: 21738100

This prospective study measured the economic impact of intraoperative waste before and after an awareness-raising program.  The program reduced waste from 4.3% of the total operative spine budget to 1.2%.  This paper shows how surgeons could save an estimated $126 million annually at the national level.

web:  http://journals.lww.com/spinejournal/pages/articleviewer.aspx?year=2011&issue=09010&article=00020&type=abstract

Posted by on Nov 16, 2011 in Economics | 0 comments

Role of ‘low cost Indian implants’ in our practice: our experience with 1,572 pedicle screws.

Rawall S, Mohan K, Nagad P, Sabnis A, Pawar U, Nene A.

Eur Spine J.  2011; 20: 1607-1612.

PMID: 21769442

This study compared 893 Indian-made vs. 679 foreign-made pedicle screws.  The difference in failure rates was not significant, but the Indian screws cost only 1/3 as much.  This paper shows the cost-savings that Western surgeons could achieve by switching their implants to generics, or patients could achieve through medical tourism.

web:  http://www.springerlink.com/content/j4x3n36851561708/fulltext.pdf

Posted by on Nov 16, 2011 in Economics | 0 comments