Diário da Espinha

Objective: Few studies have evaluated the cost effectiveness associated with lumbar microdiscectomy. The outcome data used in this analysis was from a prior randomized controlled trial (RCT) demonstrating that the use of a cryopreserved amniotic membrane (cAM) reduced the incidence of repeat procedures and improved outcomes vs. the standard of care (SOC). The purpose of this analysis was to cost out the procedural data associated with the outcomes from this RCT for cAM and then to evaluate the cost effectiveness of this alternative compared to every day practice.

Methods: The direct costs of care for patients undergoing lumbar microdiscectomy were modeled using Medicare 2017 national average reimbursement. TreeAge Pro 2018 software was used for the decision tree analysis over a 2 year period. The assumed cost of cAM was $500 US. The probabilities of events were derived from the published literature, including repeat surgery from recurrent disc herniation. The effectiveness outcome evaluated was the Ostwestry Disability Index, as evaluated in the RCT and from published literature. One-way sensitivity analysis was conducted along with Monte Carlo simulation.

Results: The use of cAM was the least costly alternative over 2 years by $343 vs. SOC ($12,417 vs. $12,760). One-way sensitivity analyses found the following variables had the greatest effect on the decision to use SOC vs. cAM (based on costs alone): incidence of revision surgery due to recurrent disc herniation for cAM (>6.8%) and SOC (<7.5%); cost of cAM (>$843); cost of an inpatient repeat procedure of <$8,408. In Monte Carlo simulation, cAM dominated 53% of the time.

Conclusion: Based on a lower incidence of repeat procedures and an improved ODI, cAM can be a cost effective alternative when compared to SOC. In today’s environment of US value based reimbursement, the use of cAM may hold promise.

Background: Spinal trauma is a well‑documented problem in developed countries but literature has been mute on this problem in developing counties. The purpose of this study was to elucidate epidemiological characteristics of spine trauma in our center over a 15-year period.

Methods: All consecutive patients with acute spinal trauma who were admitted in our center from March 2003 to March 2018 were included. The analysis was focused on patient-related demographic characteristics, cause and mechanism of injury, level and type of injury, neurological deficit, associated injuries, management and outcome. All of the statistical calculations were performed using the Statistical Package for Social Sciences (SPSS). Statistical analyses were conducted using the Student t-test and nonparametric tests (Mann-Whitney U-test, Kruskal-Wallis test). Values for p<0.05 were regarded as statistically significant and all confidence intervals were expressed at 95%.

Results: A total of 1,092 patients with acute traumatic spinal injuries were managed in our trauma center. There were 74.3% males and 25.7% females with mean age 34.5 years. Young adults (age group: 18-39 years) were more affected with 58.9%. The leading mechanism of injury was compression with 39.2%. The most common cause of accident was motor vehicle collision accident (58.5%) followed by high-energy falls (32.6%). Six hundred eighty-seven patients (62.8%) had spinal cord injury, with 14.4% complete tetraplegia and 7.7% complete paraplegia. Overall, the use of operative treatment (64.8%) exceeded that of conservative treatment (35.2%).

Conclusion: This study’s unique feature of delineating variables with statistical significance trending toward better management provides useful data to guide future researches, benchmarking, public health policy, and efficient resource allocation for the management of spine trauma.