Defining the Value of Spine Care

Spinal disorders are extremely common, debilitating, and costly to the payer and to society as a whole. The rate and cost of various spinal treatments are increasing at an astonishing rate, but it is unclear whether the resulting quality of spinal care is improving. Rather than focusing solely on quality improvement measures or cost-saving measures, there is a recent emphasis on the value of health care. Defining the value of spine care depends on a standardized, accurate method of measuring outcomes and costs. It is important that the outcomes measured are patient centered and that both the outcomes and costs are measured over time with long-term follow-up. The purpose of this article is to review current methods for measuring outcomes and propose a means by which the value of spine care can be more clearly defined.

[1]  G. Andersson,et al.  Comparative Effectiveness Evidence From the Spine Patient Outcomes Research Trial: Surgical Versus Nonoperative Care for Spinal Stenosis, Degenerative Spondylolisthesis, and Intervertebral Disc Herniation , 2011, Spine.

[2]  P. Anderson,et al.  Predicting SF-6D Utility Scores From the Neck Disability Index and Numeric Rating Scales for Neck and Arm Pain , 2011, Spine.

[3]  Jeffrey G Jarvik,et al.  Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. , 2010, JAMA.

[4]  J. Weinstein,et al.  Degenerative Spondylolisthesis: Does Fusion Method Influence Outcome? Four-Year Results of the Spine Patient Outcomes Research Trial , 2009, Spine.

[5]  S. Berven,et al.  Predicting SF-6D Utility Scores From the Oswestry Disability Index and Numeric Rating Scales for Back and Leg Pain , 2009, Spine.

[6]  John R. Johnson,et al.  RhBMP-2 Versus Iliac Crest Bone Graft for Lumbar Spine Fusion in Patients Over 60 Years of Age: A Cost-Utility Study , 2009, Spine.

[7]  J. Cairns,et al.  SF-6D versus EQ-5D: reasons for differences in utility scores and impact on reported cost-utility , 2009, The European Journal of Health Economics.

[8]  G. Andersson,et al.  Surgical treatment of spinal stenosis with and without degenerative spondylolisthesis: cost-effectiveness after 2 years. , 2008, Annals of internal medicine.

[9]  H. Malchau,et al.  Utility of Spine Surgery: A Comparison of Common Elective Orthopaedic Surgical Procedures , 2008, Spine.

[10]  J. Weinstein,et al.  Surgical Versus Nonoperative Treatment for Lumbar Disc Herniation: Four-Year Results for the Spine Patient Outcomes Research Trial (SPORT) , 2008, Spine.

[11]  S. Berven,et al.  Minimum clinically important difference in lumbar spine surgery patients: a choice of methods using the Oswestry Disability Index, Medical Outcomes Study questionnaire Short Form 36, and pain scales. , 2008, The spine journal : official journal of the North American Spine Society.

[12]  M. Robinson,et al.  Defining patient-centered, multidimensional success criteria for treatment of chronic spine pain. , 2008, Pain medicine.

[13]  Graeme Hawthorne,et al.  Deriving utility scores from the SF-36 health instrument using Rasch analysis , 2008, Quality of Life Research.

[14]  John R. Johnson,et al.  Lumbar fusion outcomes stratified by specific diagnostic indication. , 2009, The spine journal : official journal of the North American Spine Society.

[15]  S. Berven,et al.  Defining substantial clinical benefit following lumbar spine arthrodesis. , 2008, The Journal of bone and joint surgery. American volume.

[16]  Brett Hanscom,et al.  The Cost Effectiveness of Surgical Versus Nonoperative Treatment for Lumbar Disc Herniation Over Two Years: Evidence From the Spine Patient Outcomes Research Trial (SPORT) , 2008, Spine.

[17]  Ronald Brand,et al.  Prolonged conservative care versus early surgery in patients with sciatica from lumbar disc herniation: cost utility analysis alongside a randomised controlled trial , 2008, BMJ : British Medical Journal.

[18]  Brett Hanscom,et al.  Surgical versus nonsurgical therapy for lumbar spinal stenosis. , 2008, The New England journal of medicine.

[19]  R. Deyo,et al.  Expenditures and health status among adults with back and neck problems. , 2008, JAMA.

[20]  A. Greenwald,et al.  The current state of cervical and lumbar spinal disc arthroplasty. , 2007, The Journal of bone and joint surgery. American volume.

[21]  A. Copay,et al.  Understanding the minimum clinically important difference: a review of concepts and methods. , 2007, The spine journal : official journal of the North American Spine Society.

[22]  Brett Hanscom,et al.  Surgical versus nonsurgical treatment for lumbar degenerative spondylolisthesis. , 2007, The New England journal of medicine.

[23]  C. Shaffrey,et al.  SF-36 PCS Benefit-Cost Ratio of Lumbar Fusion Comparison to Other Surgical Interventions: A Thought Experiment , 2007, Spine.

[24]  C. Bünger,et al.  Costs and effects in lumbar spinal fusion. A follow-up study in 136 consecutive patients with chronic low back pain , 2007, European Spine Journal.

[25]  Alpesh A. Patel,et al.  The 36‐Item Short Form , 2007, The Journal of the American Academy of Orthopaedic Surgeons.

[26]  James N Weinstein,et al.  United States’ Trends and Regional Variations in Lumbar Spine Surgery: 1992–2003 , 2006, Spine.

[27]  J. Hartvigsen,et al.  Responsiveness and minimal clinically important difference for pain and disability instruments in low back pain patients , 2006, BMC musculoskeletal disorders.

[28]  R. Gatchel,et al.  A Cost-utility Analysis of Chronic Spinal Pain Treatment Outcomes: Converting SF-36 Data Into Quality-adjusted Life Years , 2006, The Clinical journal of pain.

[29]  F. Sassi Calculating QALYs, comparing QALY and DALY calculations. , 2006, Health policy and planning.

[30]  J. Weinstein,et al.  The Impact of Comorbidities on the Change in Short-Form 36 and Oswestry Scores Following Lumbar Spine Surgery , 2006, Spine.

[31]  H. V. van Stel,et al.  Health and Quality of Life Outcomes , 2006 .

[32]  Anoushka Singh,et al.  Quality of Life Assessment Using the Short Form-12 (SF-12) Questionnaire in Patients With Cervical Spondylotic Myelopathy: Comparison With SF-36 , 2006, Spine.

[33]  Dan Greenberg,et al.  Bias in published cost effectiveness studies: systematic review , 2006, BMJ : British Medical Journal.

[34]  S. Petrou,et al.  An investigation into the empirical validity of the EQ-5D and SF-6D based on hypothetical preferences in a general population. , 2005, Health economics.

[35]  N. Arden,et al.  Cost-effectiveness and safety of epidural steroids in the management of sciatica. , 2005, Health technology assessment.

[36]  John E. Brazier,et al.  Comparison of the minimally important difference for two health state utility measures: EQ-5D and SF-6D , 2005, Quality of Life Research.

[37]  T. Solberg,et al.  Health-related quality of life assessment by the EuroQol-5D can provide cost-utility data in the field of low-back surgery. , 2005, European Spine Journal.

[38]  S. Piva,et al.  Psychometric properties of the functional rating index in patients with low back pain , 2005, European Spine Journal.

[39]  C Fraser,et al.  Laparoscopic surgery for inguinal hernia repair: systematic review of effectiveness and economic evaluation. , 2005, Health technology assessment.

[40]  Stephen Joel Coons,et al.  US Valuation of the EQ-5D Health States: Development and Testing of the D1 Valuation Model , 2005, Medical care.

[41]  T. Ganiats,et al.  Comparison of Measured Utility Scores and Imputed Scores From the SF-36 in Patients With Rheumatoid Arthritis , 2005, Medical care.

[42]  N. Vøllestad,et al.  Concurrent Comparison of Responsiveness in Pain and Functional Status Measurements Used for Patients With Low Back Pain , 2004, Spine.

[43]  J. Brazier,et al.  A comparison of the EQ-5D and SF-6D across seven patient groups. , 2004, Health economics.

[44]  J. Fischgrund,et al.  Degenerative Lumbar Spondylolisthesis With Spinal Stenosis: A Prospective Long-Term Study Comparing Fusion and Pseudarthrosis , 2004, Spine.

[45]  David Andrew Walsh,et al.  Performance Problems of Patients With Chronic Low-Back Pain and the Measurement of Patient-Centered Outcome , 2004, Spine.

[46]  L. Prieto,et al.  Problems and solutions in calculating quality-adjusted life years (QALYs) , 2003, Health and quality of life outcomes.

[47]  John Brazier,et al.  A view from the bridge: agreement between the SF-6D utility algorithm and the Health Utilities Index. , 2003, Health economics.

[48]  D. Beaton,et al.  Measures of Health-Related Quality of Life and Physical Function , 2003, Clinical orthopaedics and related research.

[49]  R. Pietrobon,et al.  Reliability, Validity, and Responsiveness of the Short Form 12-Item Survey (SF-12) in Patients With Back Pain , 2003, Spine.

[50]  K. Tamai,et al.  Association of the Japanese Orthopaedic Association Score With the Oswestry Disability Index, Roland-Morris Disability Questionnaire, and Short-Form 36 , 2003, Spine.

[51]  Brett Hanscom,et al.  Is a Condition-Specific Instrument for Patients with Low Back Pain/Leg Symptoms Really Necessary?: The Responsiveness of the Oswestry Disability Index, MODEMS, and the SF-36 , 2003, Spine.

[52]  Plamen Nikolov,et al.  Economic Costs of Diabetes in the U.S. in 2002 , 2003, Diabetes care.

[53]  A. Nordwall,et al.  The clinical importance of changes in outcome scores after treatment for chronic low back pain , 2003, European Spine Journal.

[54]  L. Göeken,et al.  Concurrent Validity of Questionnaire and Performance-Based Disability Measurements in Patients with Chronic Nonspecific Low Back Pain , 2002, Journal of Occupational Rehabilitation.

[55]  J. Brazier,et al.  The estimation of a preference-based measure of health from the SF-36. , 2002, Journal of health economics.

[56]  H R Rubin,et al.  The advantages and disadvantages of process-based measures of health care quality. , 2001, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[57]  J. Mant Process versus outcome indicators in the assessment of quality of health care. , 2001, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[58]  A. Nordwall,et al.  2001 Volvo Award Winner in Clinical Studies: Lumbar Fusion Versus Nonsurgical Treatment for Chronic Low Back Pain: A Multicenter Randomized Controlled Trial From the Swedish Lumbar Spine Study Group , 2001, Spine.

[59]  A. Garratt,et al.  Responsiveness of Generic and Specific Measures of Health Outcome in Low Back Pain , 2001, Spine.

[60]  P. Pynsent,et al.  The Oswestry Disability Index. , 2000, Spine.

[61]  Michael E. Chernew,et al.  Willingness to Pay for a Quality-adjusted Life Year , 2000, Medical decision making : an international journal of the Society for Medical Decision Making.

[62]  R. K. Snider,et al.  Cost-effectiveness of fusion with and without instrumentation for patients with degenerative spondylolisthesis and spinal stenosis. , 2000, Spine.

[63]  M. Foy,et al.  Responsiveness of common outcome measures for patients with low back pain. , 1999, Spine.

[64]  J. Brazier,et al.  Deriving a preference-based single index from the UK SF-36 Health Survey. , 1998, Journal of clinical epidemiology.

[65]  M. Mackay,et al.  1997 Volvo Award Winner in Clinical Studies: Degenerative Lumbar Spondylolisthesis With Spinal Stenosis: A Prospective, Randomized Study Comparing Decompressive Laminectomy and Arthrodesis With and Without Spinal Instrumentation , 1997, Spine.

[66]  D. Meier,et al.  [Assessment of the quality of life]. , 1997, Therapeutische Umschau. Revue therapeutique.

[67]  Robert A. Lew,et al.  Lumbar Laminectomy Alone or With Instrumented or Noninstrumented Arthrodesis in Degenerative Lumbar Spinal Stenosis: Patient Selection, Costs, and Surgical Outcomes , 1997, Spine.

[68]  W F Lawrence,et al.  Predicting Quality of Well-being Scores from the SF-36 , 1997, Medical decision making : an international journal of the Society for Medical Decision Making.

[69]  H. Herkowitz,et al.  Spinal Instrumentation in the Management of Degenerative Disorders of the Lumbar Spine , 1997, Clinical orthopaedics and related research.

[70]  Sidhu Ks,et al.  Spinal instrumentation in the management of degenerative disorders of the lumbar spine. , 1997 .

[71]  R. Leclaire,et al.  A Cross‐sectional Study Comparing the Oswestry and Roland‐Morris Functional Disability Scales in Two Populations of Patients With Low Back Pain of Different Levels of Severity , 1997, Spine.

[72]  M. Weinstein,et al.  Recommendations of the Panel on Cost-effectiveness in Health and Medicine. , 1996, JAMA.

[73]  D. Grob,et al.  Predictors of Bad and Good Outcome of Lumbar Spine Surgery: A Prospective Clinical Study With 2 Years' Follow‐up , 1996, Spine.

[74]  R. Deyo,et al.  Cost‐Effectiveness of Lumbar Discectomy for the Treatment of Herniated Intervertebral Disc , 1996, Spine.

[75]  J. Ware,et al.  A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. , 1996, Medical care.

[76]  T. Ganiats,et al.  Comparison of two methods of calculating Quality-adjusted Life Years , 1996, Quality of Life Research.

[77]  M. Liang,et al.  Relative responsiveness of condition-specific and generic health status measures in degenerative lumbar spinal stenosis. , 1995, Journal of clinical epidemiology.

[78]  D. Singer,et al.  Assessing Health‐Related Quality of Life in Patients With Sciatica , 1995, Spine.

[79]  H C de Vet,et al.  Measuring the Functional Status of Patients With Low Back Pain: Assessment of the Quality of Four Disease-Specific Questionnaires , 1995, Spine.

[80]  R. Deyo,et al.  Lumbar spinal fusion. A cohort study of complications, reoperations, and resource use in the Medicare population. , 1993, Spine.

[81]  M. Abdalla,et al.  The SF36 health survey questionnaire: an outcome measure suitable for routine use within the NHS? , 1993, BMJ.

[82]  J. Haselkorn,et al.  Patient outcomes after lumbar spinal fusions. , 1992, JAMA.

[83]  J. E. Brazier,et al.  Validating the SF-36 health survey questionnaire: new outcome measure for primary care. , 1992, BMJ.

[84]  C. Sherbourne,et al.  The MOS 36-Item Short-Form Health Survey (SF-36) , 1992 .

[85]  A S Detsky,et al.  How attractive does a new technology have to be to warrant adoption and utilization? Tentative guidelines for using clinical and economic evaluations. , 1992, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[86]  H N Herkowitz,et al.  Degenerative lumbar spondylolisthesis with spinal stenosis. A prospective study comparing decompression with decompression and intertransverse process arthrodesis. , 1991, The Journal of bone and joint surgery. American volume.

[87]  S Senn,et al.  Analysis of serial measurements in medical research. , 1990, BMJ.

[88]  A. Enthoven Shattuck Lecture--cutting cost without cutting the quality of care. , 1978, The New England journal of medicine.

[89]  W. M. Barclay Surgery , 1894, Bristol medico-chirurgical journal.

[90]  W. B. van den Hout,et al.  The value of productivity: human-capital versus friction-cost method , 2009, Annals of the Rheumatic Diseases.

[91]  P. Huddleston Minimum clinically important difference in lumbar spine surgery patients: a choice of methods using the Oswestry Disability Index, Medical Outcomes Study questionnaire Short Form 36, and Pain Scales , 2009 .

[92]  J. Stockman Surgical vs Nonoperative Treatment for Lumbar Disk Herniation: The Spine Patient Outcomes Research Trial (SPORT): A Randomized Trial , 2008 .

[93]  J. Stockman Surgical vs Nonoperative Treatment for Lumbar Disk Herniation: The Spine Patient Outcomes Research Trial (SPORT) Observational Cohort , 2008 .

[94]  J. Caro,et al.  A systematic review of low back pain cost of illness studies in the United States and internationally. , 2008, The spine journal : official journal of the North American Spine Society.

[95]  J. Ware SF-36 health survey: Manual and interpretation guide , 2003 .

[96]  Jennifer L Keating,et al.  A comparison of five low back disability questionnaires: reliability and responsiveness. , 2002, Physical therapy.

[97]  P. Fritzell Fusion Versus Nonsurgical Treatment for Chronic Low Back Pain , 2001 .

[98]  M. Grevitt,et al.  The Short Form-36 Health Survey Questionnaire In Spine Surgery , 1997 .

[99]  John E. Ware,et al.  SF-36 physical and mental health summary scales : a user's manual , 1994 .

[100]  A. Williams EuroQol : a new facility for the measurement of health-related quality of life , 1990 .

[101]  C. R. Weatherley,et al.  Discogenic pain persisting despite solid posterior fusion. , 1986, The Journal of bone and joint surgery. British volume.