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Study examines spinal procedureís cost effectiveness

BY: LESLIE HILL

8/11/2011 - 

Matthew McGirt, M.D.

Matthew McGirt, M.D.

The main crux of health care reform is how to balance cost-effectiveness with quality of care, and Vanderbilt University Medical Center’s Department of Neurological Surgery is tackling this issue head-on.

“Seventeen percent of the U.S.’s gross domestic product goes to health care, 7 percent of that to surgery. How to reduce cost without adversely affecting quality of care is the trillion-dollar question,” said Matthew McGirt, M.D., assistant professor of Neurological Surgery. “We want to develop true value-based health care, which balances the benefit with the cost.”

McGirt was an author on the study, “Cost-effectiveness of transforaminal lumbar interbody fusion for Grade I degenerative spondylolisthesis,” published in the August issue of the Journal of Neurosurgery: Spine, which is the department’s first of many efforts at determining the value of a spine surgery procedure.

The widely accepted definition of “value” is the two-year cost (including the cost of medical care, lost wages and other incidental expenses) per quality of life year gained. A value less than $50,000 is considered cost-effective.

For degenerative spondylolisthesis — a spine condition in which one vertebra slips forward over the one below, causing lower back and leg pain — McGirt and his colleagues measured the value of spinal fusion treatment at $42,854 per quality of life year gained, suggesting that the surgery is a cost-effective solution.

“Spinal fusion is often viewed as a very expensive procedure, but compare that number with the widely-accepted procedures like total knee replacement, which has been reported at $59,262. That shows we don’t always know the true value of a medical intervention at first glance,” McGirt said.

“The Health Reform Act says we must define the value of the care we give, and though we did find spinal fusion to be cost-effective, we ultimately have to be honest and unbiased because not all the things we do will be valuable. We have to police ourselves and eliminate low-value surgeries.”

McGirt said duplicating this study for other spinal procedures will be easy because the necessary data collection tools have been integrated into the standard of spine care at VUMC, including cost calculators built into the electronic medical record and research staff who follow-up with patients about their quality of life outside the hospital, including additional costs and health improvements.

“We’re applying value analysis to the real world clinical situation, not a tightly-controlled research setting, which allows us to collect data on the standard of care without affecting it,” McGirt said.

“Vanderbilt Neurosugery is becoming a true leader in this area. We’re first in a new era of clinical science, responding to the call of health care reform and actually doing it.”

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