Value-based care in the management of spinal disorders: A systematic review of cost-utility analysis

Santoshi S. Indrakanti, Michael H. Weber, Steven K. Takemoto, Serena S. Hu, David Polly, Sigurd H. Berven

Research output: Contribution to journalArticlepeer-review

54 Scopus citations


Background: Spinal disorders are a major cause of disability and compromise in health-related quality of life. The direct and indirect costs of treating spinal disorders are estimated at more than $100 billion per year. With limited resources, the cost-utility of interventions is important for allocating resources. Questions/purposes: We therefore performed a systematic review of the literature on cost-utility for nonoperative and operative interventions for treating spinal disorders. Methods: We searched four databases for cost-utility analysis studies on low back pain management and identified 1004 items. The titles and abstracts of 752 were screened before selecting 27 studies for inclusion; full texts of these 27 studies were individually evaluated by five individuals. Results: Studies of nonoperative treatments demonstrated greater value for graded activity over physical therapy and pain management; spinal manipulation over exercise; behavioral therapy and physiotherapy over advice; and acupuncture and exercise over usual general practitioner care. Circumferential fusion and femoral ring allograft had greater value than posterolateral fusion and titanium cage, respectively. The relative cost-utility of operative versus nonoperative interventions was variable with the most consistent evidence indicating superior value of operative care for treating spinal disorders involving nerve compression and instability. Conclusion: The literature on cost-utility for treating spinal disorders is limited. Studies addressing cost-utility of nonoperative and operative management of low back pain encompass a broad spectrum of diagnoses and direct comparison of treatments based on cost-utility thresholds for comparative effectiveness is limited by diversity among disorders and methods to assess cost-utility. Future research will benefit from uniform methods and comparison of treatments in cohorts with well-defined pathology.

Original languageEnglish (US)
Pages (from-to)1106-1123
Number of pages18
JournalClinical orthopaedics and related research
Issue number4
StatePublished - Apr 2012


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