Cost-effectiveness of lumbar discectomy.

Cost-effectiveness analysis is useful when attempting to determine whether the benefits of an intervention are worth is costs. It can help clinicians to consider more explicitly all potential costs and outcomes of a given treatment, and it can assist policy makers in determining how best to allocate limited health-care resources to maximize the health of a population. This article describes the research methods used to estimate cost-effectiveness, and then examines existing reports on the cost-effectiveness of lumbar disc surgery. Results of previously published studies were inconsistent, indicating that estimates of discectomy's cost-effectiveness are highly dependent on how one measures and values the improvement in quality of life resulting from the procedure. If only long-term outcomes are considered, the procedure appears no more effective than continued medical treatment. But discectomy seems effective when its short-term benefits are considered. In either case, costs for the procedure are moderate. The authors conclude that for carefully selected patients with herniated lumbar discs, short-term quality of life is improved substantially with surgical versus medical treatment. When this benefit is considered, discectomy appears to be a cost-effective intervention, although this conclusion applies only to carefully selected patients with clearly defined indications for surgery. For patients without these indications and for patients in whom the immediate relief of sciatica is less important, discectomy's cost-effectiveness will be less favorable.