PMID- 30985570
OWN - NLM
STAT- MEDLINE
DCOM- 20200106
LR  - 20210115
IS  - 1528-1159 (Electronic)
IS  - 0362-2436 (Linking)
VI  - 44
IP  - 18
DP  - 2019 Sep
TI  - The Association Between Patient Reported Outcomes of Spinal Surgery and Societal 
      Costs: A Register Based Study.
PG  - 1309-1317
LID - 10.1097/BRS.0000000000003050 [doi]
AB  - STUDY DESIGN: Retrospective register-based study using Swedish registers and data 
      prospectively collected in quality register Swespine. OBJECTIVE: Analyze the 
      association of societal costs and spine surgery outcome in low back pain (LBP) 
      patients based on patient reported outcome measures (PROMs). SUMMARY OF 
      BACKGROUND DATA: Studies show that LBP has a substantial impact on societal cost. 
      There are indications that the burden diverges over different patient groups, but 
      little is known about cost patterns in relation to PROMs of LBP surgery. METHODS: 
      We utilized a database with data from six registers. All lumbar spine surgery 
      patients registered in Swespine 2000 to 2012 were identified. Swespine collects 
      PROMs Global Assessment of pain improvement (GA), Oswestry Disability Index 
      (ODI), Visual Analog Scale (VAS), and EuroQol five-dimension scale (EQ-5D). A 
      literature search was conducted to identify threshold changes in ODI, VAS, and 
      EQ-5D representing a significant improvement or deterioration as defined by the 
      minimal clinically important difference (MCID). We categorized patients into 
      groups by their GA response at 2-year follow-up and estimated mean changes in 
      ODI, VAS, and EQ-5D for each group. These changes were compared with the MCID 
      thresholds to determine a GA-anchored classification of surgical outcomes. Costs 
      consisted of out/inpatient care, sick leave, early retirement, and 
      pharmaceuticals. RESULTS: In total, 12,350 patients were included. GA 1-2 ("pain 
      has disappeared"/"pain is much improved") were labeled successful surgery 
      outcomes (67%), GA 3 ("pain somewhat improved"), undetermined (16%), and GA 4-5 
      ("no change in pain"/"pain has worsened") unsuccessful (17%). Costs of the 
      unsuccessful and undetermined were higher than of the successful during the 
      entire study period, with differences increasing markedly post-surgery. For the 
      successful, a downward cost trend was observed; costs almost returned to the 
      level observed 3 years pre-surgery. No such trend was observed in the other 
      groups. CONCLUSION: Identifying patients with higher probability of responding to 
      surgery could lead to improved health and substantial societal cost savings. 
      LEVEL OF EVIDENCE: 3.
FAU - Hansson-Hedblom, Amanda
AU  - Hansson-Hedblom A
AD  - Quantify Research, Stockholm, Sweden.
FAU - Jonsson, Emma
AU  - Jonsson E
AD  - Quantify Research, Stockholm, Sweden.
FAU - Fritzell, Peter
AU  - Fritzell P
AD  - Department of Surgical Sciences, Uppsala University Hospital, Sweden.
AD  - Futurum-Academy for Health and Care, Ryhov Jonkoping, Sweden.
FAU - Hagg, Olle
AU  - Hagg O
AD  - Spine Center Goteborg, Gothenburg, Sweden.
FAU - Borgstrom, Fredrik
AU  - Borgstrom F
AD  - Quantify Research, Stockholm, Sweden.
AD  - Department of Learning, Informatics, Management and Ethics/Medical Management 
      Centrum, Karolinska Institutet, Stockholm, Sweden.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Spine (Phila Pa 1976)
JT  - Spine
JID - 7610646
SB  - IM
MH  - Adult
MH  - Aged
MH  - Disability Evaluation
MH  - Female
MH  - Humans
MH  - Low Back Pain/*economics/*surgery
MH  - Male
MH  - Middle Aged
MH  - Neurosurgical Procedures/*economics
MH  - Pain Measurement
MH  - *Patient Reported Outcome Measures
MH  - Registries
MH  - Retrospective Studies
MH  - Sweden
MH  - Treatment Outcome
MH  - Visual Analog Scale
EDAT- 2019/04/16 06:00
MHDA- 2020/01/07 06:00
CRDT- 2019/04/16 06:00
PHST- 2019/04/16 06:00 [pubmed]
PHST- 2020/01/07 06:00 [medline]
PHST- 2019/04/16 06:00 [entrez]
AID - 00007632-201909150-00015 [pii]
AID - 10.1097/BRS.0000000000003050 [doi]
PST - ppublish
SO  - Spine (Phila Pa 1976). 2019 Sep;44(18):1309-1317. doi: 
      10.1097/BRS.0000000000003050.