Cost-Utility Analysis of a pre-, peri- and postoperative rehabilitation pathway versus usual care in patients undergoing lumbar fusion surgery

Abstract

Introduction

The REACT trial demonstrated that a pre-, peri- and postoperative rehabilitation pathway (i.e. REACT rehabilitation) was associated with greater improvements in disability, back pain, and return-to-work rate, compared with usual care, after lumbar fusion surgery (LFS).

Research question

To assess the potential cost-utility of the REACT rehabilitation relative to usual care in patients undergoing LFS for degenerative conditions.

Materials and methods

A cost-utility analysis over a six-month time horizon was conducted using data from the REACT trial from the perspective of the Belgian healthcare system. A secondary analysis from a societal perspective included indirect costs associated with productivity losses. Probabilistic sensitivity analysis evaluated uncertainty. Primary outcomes were differences in costs, quality-adjusted life years (QALY), and incremental cost-effectiveness ratio (ICER).

Results

The main analysis included 72 patients (mean age 55.1 years [SD 14.1], 59.7% female). The REACT rehabilitation reduced outpatient medical costs (p < 0.0001) and indirect costs (p < 0.0001), with a trend toward lower hospitalization costs (p = 0.07), despite higher rehabilitation costs (p = 0.002). There was no significant QALY improvement. The resulting ICER of −87,762.78€/QALY indicated that REACT rehabilitation was more effective and less costly than usual care. Probabilistic sensitivity analysis revealed a high probability of being cost-effective (92.8%).

Secondary analysis confirmed the cost-utility of REACT rehabilitation when including indirect costs.

Discussion and conclusion

In this cost-utility analysis, the REACT rehabilitation was cost-effective compared to usual care for patients undergoing LFS. Although the REACT rehabilitation did not significantly enhance QALY or decrease total direct costs, it significantly reduced indirect costs, which outweighed direct costs in patients undergoing LFS.