Spine Journal - 2026-06-02 - Journal Article
1-2 Level Lateral Single Position Surgery is Highly Cost-Effective in the Treatment of Surgically Indicated Degenerative Lumbar Spinal Pathology.
Cordeiro LE, Yasein A, Oskouei ST, Buckland AJ
Topics
Key Takeaway
1-2 level lateral single position anteroposterior fusion (LSPS) achieves a cost per QALY of $46,736 USD at 2 years, meeting the WHO 'highly cost-effective' threshold (<1× GDP/capita) by 20 months postoperatively.
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Summary
This prospective cohort evaluated the cost-utility of 1-2 level LSPS for degenerative lumbar pathology in 90 patients using EQ5D-3L-derived QALYs and comprehensive cost accounting at 2022 USD values. EQ5D-3L improved from 0.55 to 0.78 (QALY gain 0.227) and ODI improved from 40 to 15-16 at 1-2 years; mean procedure cost was $27,413 USD with device costs comprising 46% of total expenditure. Cost per QALY fell from $104,254 at 1 year to $46,736 at 2 years, crossing the WHO highly cost-effective threshold by 20 months.
Key Limitation
Single-center, single-arm design without a comparator group prevents determination of whether LSPS is more or less cost-effective than TLIF, PLIF, or decompression alone for equivalent pathology.
Original Abstract
BACKGROUND
The cost-utility of lumbar fusion remains variable and poorly validated, with debate regarding its value. This study aimed to evaluate the cost-effectiveness of 1-2 level Lateral Single Position Anterio-Posterior Fusion Surgery (LSPS) using prospectively collected patient-reported outcome measures (PROMs) to derive cost per QALY estimates over two years.
PURPOSE
To evaluate the cost-effectiveness of 1-2 level Lateral Single Position Anterio-Posterior Fusion Surgery (LSPS) using prospectively collected patient-reported outcome measures (PROMs) to derive cost per quality-adjusted life year (QALY) estimates over two years.
STUDY DESIGN/SETTING
Prospective consecutive cohort study conducted at a tertiary spine centre.
PATIENT SAMPLE
A cohort of 90 patients undergoing primary 1-2 level LSPS between 2020 and 2023.
OUTCOME MEASURES
EuroQol 5 Dimension (EQ5D-3L), Oswestry Disability Index (ODI), QALYs, total costs, cost per QALY.
METHODS
EuroQol 5 Dimension (EQ5D-3L) and Oswestry Disability Index (ODI) scores were collected pre-operatively and at 3, 6, 12, and 24 months. QALYs were calculated using the improvement in health index score at each timepoint relative to pre-operatively. All costs were included at 2022 values using publicly available data and discounted at 3.5% while health index at 3% annually. Costs were reported in USD, and the cost-effectiveness was evaluated against World Health Organization (WHO) willingness-to-pay models based on gross domestic product (GDP) per capita.
RESULTS
90 patients underwent 1-2 level LSPS, mean age 65.6 years, BMI 28.0 kg/m², 37% male. EQ5D-3L index values improved from 0.55 at baseline to 0.78 at one-year and two-year follow-up (p<0.001), reflecting a QALY gain of 0.227. Mean ODI improved from 40 to 16 at 1-year and 15 at 2-year follow-up (p<0.001). The mean cost of the procedure was $27,413 USD (IQR $21,069-$32,059 USD). 4.4% required rehabilitation and 6.7% required re-operation within 2-years (3.3% decompression at index level, 2.2 % decompression at adjacent level and 1.1% fusion at adjacent level). Contributors to total costs included device costs ($12,603 USD; 46% of total), hospital charges ($7,442 USD, 27%), medical fees ($5,882 USD, 21%), and inpatient rehabilitation (0.7%). Cost per QALY decreased markedly over time, reaching $104,254 USD at 1 year to $46,736 USD at 2 years. By 20 months post-operatively, the cost per QALY met the WHO-CHOICE 'highly cost effective' benchmark of <1× GDP/capita (∼$65,078 USD) and fell within the empirically derived 0.5-1.5× GDP range ($32,539-$97,617 USD/QALY), indicating high cost-effectiveness.
CONCLUSION
1-2 level LSPS is a highly cost-effective procedure for the treatment of degenerative lumbar spinal pathologies that are surgically indicated.