TLIF, LLIF Procedures Equivalent in Cost

In a comparison of physician, hospital and other charges for lateral lumber interbody fusion and transforaminal lumbar interbody fusion, researchers found both procedures led to two-year outcomes that were equivalent in terms of cost-effectiveness.

“We found the lateral lumber interbody fusion (LLIF) surgery costs an additional $20,000 to provide one additional quality-adjusted life year (QALY) compared with a transforaminal lumbar interbody fusion (TLIF),” said Gurpreet Surinder Gandhoke, M.D., a Pittsburgh, Pa., neurosurgeon who conducted the research along with colleagues.

Despite the additional cost, however, the data concluded the two procedures produced an equivalent two-year patient outcome with an equivalent cost-effectiveness profile.

Gandhoke said he decided to study this area because third-party payers sometimes reimburse for new technology at lower rates unless there are cost-effectiveness data to support use of the technology.

He and his colleagues calculated the incremental cost-effectiveness ratio (ICER) of the two procedures and sought to determine any differences between them in the corresponding QALY calculations done with the EuroQol-5D.

They obtained costs from a single-center database in a unified health care system for treating patients with degenerative spondylosis who had low back and leg pain.

“We calculated both the direct and the indirect costs,” Gandhoke said.

Single-level TLIF was performed in 45 patients and single-level LLIF was performed in 29 patients. Findings showed a mean total cost of care following TLIF and LLIF of $53,038 and $55,464, respectively, which included costs from the time patients were diagnosed until 2 years postoperatively. The difference between the costs was not statistically significant, according to the researchers.

Among the outcome measures used in the study were the SF-36 physical component summary, the Oswestry Disability Index and VAS scores for both back and leg pain.