Author/Authors :
Yaghoubi, Mohsen Department of Community Medicine - School of Medicine - Iran University of Medical Sciences, Tehran, Iran , Moradi-Lakeh, Maziar Department of Community Medicine - School of Medicine - Iran University of Medical Sciences, Tehran, Iran , Moradi-Joo, Mohammad Cancer Research Center - Shahid Beheshti University of Medical Sciences, Tehran, Iran , Rahimi-Movaghar, Vafa Sina Trauma and Surgery Research Center - Tehran University of Medical Sciences, Tehran, Iran , Zamani, Neda Department of Community Medicine - School of Medicine - Isfahan University of Medical Sciences, Isfahan, Iran , Naghibzadeh-Tahami, Ahmad Epidemiology Physiology Research Center - Institute of Neuropharmacology - Kerman University of Medical Sciences, Kerman, Iran
Abstract :
Background: The present study aims to evaluate the cost-effectiveness of Dynamic Interspinous
Spacer (Coflex®) and Static Spacer (X-STOP ®) compared to Laminectomy (LAMI) in patients
with lumbar spinal stenosis.
Methods: A decision-analysis model was developed to estimate the cost-effectiveness. The effectiveness
parameters were obtained from a systematic literature review in relevant databases including
PUBMED and EMBASE. A meta-analysis was performed using the STATA statistical package and
a random model was used to collect measures of mean difference of visual analogue scale (VAS)
pain score before and after intervention in X-stop, Coflex and LAMI (95% confidence intervals).
Cost data were obtained from provider and associated literature based on health care provider prospective.
We assumed that the probability of the success rate of surgery in each intervention from
associated literature and calculated Incremental cost effectiveness ratio. A one-way sensitivity analysis
was also carried out.
Results: Twenty-four out of 294 studies are included in the Meta-analysis. The overall pooled estimate
of the mean difference of VAS pain score were 3.49 (95% CI 3.7-4.2) and 4.14 (95% CI 3.09-
5.19) for X-stop and Coflex, respectively. In addition, we assumed the overall pooled estimate of 5.3
(95% CI 2.15-7.4) on the basis of literature for LAMI. The average cost per LAMI surgery, X-stop
and Coflex was US$ 3019, US$ 2022 and US$ 2566, respectively. Incremental cost effectiveness
ratio of X-stop and Coflex versus LAMI was US$ 665.9 and US$ 780.7, respectively.
Conclusion: Static Interspinous Spacer (X-stop) appears to be the most cost-effective treatment
strategy in base case scenario with success rate of LAMI (range between (55%-70%). A sensitivity
analysis shows that the increase probability of success rate of LAMI was more than 70 % and less
than 55% which lead to the cost effectiveness of the Coflex intervention.
Keywords :
lumbar vertebrae , cost-effectiveness , spinal stenosis , interspinous , laminectomy
