Please use this identifier to cite or link to this item: http://hdl.handle.net/1893/22784
Appears in Collections:Faculty of Health Sciences and Sport Journal Articles
Peer Review Status: Refereed
Title: 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
Authors: Rivero-Arias, Oliver
Campbell, Helen
Gray, Alastair
Fairbank, Jeremy C T
Frost, Helen
Wilson-MacDonald, James
Contact Email: helen.frost@stir.ac.uk
Issue Date: 26-Aug-2005
Publisher: BMJ Publishing Group
Citation: Rivero-Arias O, Campbell H, Gray A, Fairbank JCT, Frost H & Wilson-MacDonald J (2005) 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, BMJ, 330 (7502), pp. 1239-1243.
Abstract: Objective To determine whether, from a health provider and patient perspective, surgical stabilisation of the spine is cost effective when compared with an intensive programme of rehabilitation in patients with chronic low back pain.  Design Economic evaluation alongside a pragmatic randomised controlled trial.  Setting Secondary care.  Participants 349 patients randomised to surgery (n = 176) or to an intensive rehabilitation programme (n = 173) from 15 centres across the United Kingdom between June 1996 and February 2002.  Main outcome measures Costs related to back pain and incurred by the NHS and patients up to 24 months after randomisation. Return to paid employment and total hours worked. Patient utility as estimated by using the EuroQol EQ-5D questionnaire at several time points and used to calculate quality adjusted life years (QALYs). Cost effectiveness was expressed as an incremental cost per QALY.  Results At two years, 38 patients randomised to rehabilitation had received rehabilitation and surgery whereas just seven surgery patients had received both treatments. The mean total cost per patient was estimated to be £7830 (SD £5202) in the surgery group and £4526 (SD £4155) in the intensive rehabilitation arm, a significant difference of £3304 (95% confidence interval £2317 to £4291). Mean QALYs over the trial period were 1.004 (SD 0.405) in the surgery group and 0.936 (SD 0.431) in the intensive rehabilitation group, giving a non-significant difference of 0.068 (–0.020 to 0.156). The incremental cost effectiveness ratio was estimated to be £48 588 per QALY gained (–£279 883 to £372 406).  Conclusion Two year follow-up data show that surgical stabilisation of the spine may not be a cost effective use of scarce healthcare resources. However, sensitivity analyses show that this could change—for example, if the proportion of rehabilitation patients requiring subsequent surgery continues to increase.
Type: Journal Article
URI: http://hdl.handle.net/1893/22784
DOI Link: http://dx.doi.org/10.1136/bmj.38441.429618.8F
Rights: Publisher is open-access. Open access publishing allows free access to and distribution of published articles where the author retains copyright of their work by employing a Creative Commons attribution licence. Proper attribution of authorship and correct citation details should be given. Published in BMJ 2005;330:1239.
Affiliation: University of Oxford
University of Oxford
University of Oxford
Nuffield Orthopaedic Centre
NMAHP Research
Nuffield Orthopaedic Centre

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