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Function After Spinal Treatment, Exercise, and Rehabilitation: Cost-Effectiveness Analysis Based on a Randomized Controlled Trial

Morris, Stephen PhD*; Morris, Tim P. BSc; McGregor, Alison H. PhD; Doré, Caroline J. BSc; Jamrozik, Konrad PhD

doi: 10.1097/BRS.0b013e31821cba1f
Health Services Research

Study Design. Cost-effectiveness analysis alongside a factorial randomized controlled trial.

Objective. To assess the cost-effectiveness of a rehabilitation program and/or an education booklet each compared with usual care for the postoperative management of patients undergoing discectomy or lateral nerve root decompression surgery.

Summary of Background Data. There is little knowledge about the cost-effectiveness of postoperative management of patients after spinal surgery.

Methods. A total of 338 patients were recruited into the study between June 2005 and March 2009. Patients were randomized to rehabilitation only, booklet only, rehabilitation plus booklet, or usual care only. Interactions between booklet and rehabilitation were nonsignificant; hence, we compare booklet versus no booklet and rehabilitation versus no rehabilitation. We adopt an English National Health Service and personal social services perspective. Data on outcomes and costs are based on patient level data from the trial. A 1-year time horizon was used. Outcomes were measured in terms of quality-adjusted life years. Health-related quality of life was reported by patients using the EuroQol-5D (EQ-5D). A comprehensive range of health service contacts were included in the cost analysis.

Results. There were no significant differences in costs or outcomes associated with either intervention. Mean incremental costs and mean quality-adjusted life years gained per patient of booklet versus no booklet were −£87 (95% CI: −£1221 to £1047) and −0.023 (95% CI: −0.068 to 0.023), respectively. Figures for rehabilitation versus no rehabilitation were £160 (95% CI: −£984 to £1304) and 0.002 (95% CI: −0.044 to 0.048), respectively. Neither intervention was cost-effective when compared with the threshold range commonly used to judge whether or not an intervention is cost-effective in the English National Health Service.

Conclusion. Cost-effectiveness evidence does not support use of booklet over no booklet or rehabilitation over no rehabilitation for the postoperative management of patients after spinal surgery.

We undertook a cost-effectiveness analysis of a rehabilitation program and an education booklet for the postoperative management of patients following spinal surgery. There were no significant differences in costs or benefits with either intervention, and neither was cost-effective when compared with the cost-effectiveness threshold commonly used in the English NHS.

*Research Department of Epidemiology and Public Health, University College London, London, UK;

MRC Clinical Trials Unit, London NW1 2DA, UK;

Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, UK;

School of Population Health and Clinical Practice Office, University of Adelaide, South Australia, Australia.

Address correspondence and reprint requests to Stephen Morris, PhD, Research Department of Epidemiology and Public Health, UCL, Gower Street, London WC1E 6BT, UK; E-mail:

Acknowledgment date: October 19, 2010. Revision date: January 21, 2011. Acceptance date: March 17, 2011.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Foundation funds were received to support this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

© 2011 Lippincott Williams & Wilkins, Inc.