Cost-benefit analysis of posterior fusion of the lumbosacral spine.

In this study the cost-benefit ratio of posterior fusion of the lumbosacral spine was assessed. The calculations were based on 118 operated patients, followed up for an average of 4.8 years. Costs were calculated using the average costs of treatment at central hospitals, visits to the outpatient department and travelling. The costs for one patient exceeded on average 5,569 US dollars. The economic benefits derived from the operations were estimated by the work output of those 36 patients who postoperatively returned to their previous or a corresponding occupation. The postoperative work output was estimated using the coefficients for known causes of retirement (emigration, mortality, disability). The benefits of one lumbosacral fusion amounted on average to 16,075 US dollars. Fusion of the lumbosacral spine prove to be profitable at a cost-benefit ratio of 1 : 2.9. If the selection of patients for operation could be made so as to guarantee that working capacity is restored by operative treatment, the cost-benefit ratio might be improved to 1 : 9.5. It is emphasized that cost-benefit analyses of surgical procedures are important from the standpoint of principles of treatment and priority of operations. This study deals with economic aspects only. The medical aspects of the present material have been presented in two previous papers.