Study finds TLIF more cost-effective vs AP fusion for lumbar spondylolisthesis
Boston — Transforaminal lumbar interbody fusion was more cost-effective than anteroposterior fusion for the treatment of patients with lumbar spondylolisthesis, according to a presenter, here.
“Overall costs were similar at index in 1 year between anteroposterior [AP] and [transforaminal lumbar interbody fusion] TLIF for lumbar spondylolisthesis and [quality-adjusted life years] QALYs again were similar between cohorts at 1 year,” Jeffrey L. Gum, MD, said at the North American Spine Society Annual Meeting. “Although there is no statistical difference between the cost or QALYs, TLIF was a bit cheaper and had a bit better QALYs gained. So, it was the dominant intervention.”
Gum and colleagues identified 723 patients with lumbar spondylolisthesis. Of these, a cohort of 33 patients who underwent AP fusion and 33 propensity-matched patients who underwent TLIF were included in the study. Patients were matched according to age, gender, BMI, smoking status, workers’ compensation, preoperative Oswestry Disability Index (ODI), back pain and leg pain. Investigators used baseline and 1-year SF-6D scores to determine QALYs gained.
Findings showed no significant differences between groups for age, BMI, smoking status, workers’ compensation and baseline back pain and ODI. Gum said patients were also similar with regard to surgical characteristics, but he noted length of stay was longer in AP fusion group compared with the TLIF group. However, this difference was not significant.
At 1 year, the QALYs gained in the AP fusion group and TLIF group were 0.12 and 0.14, respectively. Gum noted the mean costs for AP fusion and TLIF were about $36,000 and $29,000 respectively; however, the difference was not significant. The final costs including revision and readmission were also not significant at about $36,000 and $30,000, respectively. – by Monica Jaramillo
Gum JL, et al. Paper #28. Presented at: North American Spine Society Annual Meeting; Oct. 26-29, 2016; Boston.
Disclosure: Gum reports he is a consultant for LifeSpine, Medtronic, DePuy, Alphatec, Stryker, Acuity and PAKmed; has speaking and/or teaching arrangements with MiMedx and Pacira Pharmaceuticals; receives grants from Fischer Owen Fund; is a reviewer for NuVasive and is paid directly by the International Spine Study Group Foundation and Integra.