Medicoeconomic evaluation of total disc replacement based on French National Health Care System data

Summary Introduction Total disc replacement (TDR) has existed since 1984 but is not covered by the French national healthcare system ( Sécurité Sociale ). The present study assessed clinical outcomes, and also pre-, peri- and postoperative treatment costs. Hypothesis Surgical management of low back pain (LBP) provides medical and economic benefit. Materials and methods A prospective study recruited 19 patients in the Nice University Hospital Center (France); mean age, 41 years; 15 female. Inclusion criteria were: age less than 60 years; chronic low back pain (LBP) with single-segment discopathy; work related injuries and patients not covered under the General provision of the Sécurité Sociale were excluded. VAS, Oswestry and SF36 scores and return to work capability were analyzed. The local national health insurance branch office ( Caisse Primaire d’Assurance Maladie [CPAM]) provided detailed coverage data for a 39-month period around the operation. Results Revision surgery was required for one instance of vertebral fracture. Preoperative follow-up was 14 months, postoperative FU 21 months and the perioperative period 4 months. LBP and quality of life showed improvement. Seventy-nine percent of patients reported satisfaction, 59% returned to work, and 84% had leisure activity. Total CPAM payout (reimbursement) was € 399,082. Daily sickness benefit and disability compensation were the main cost items. Mean TDR cost per patient was € 6833. Mean reimbursements were 19% lower post- than preoperatively. Pre- and postoperative clinical results did not correlate, while pre- and postoperative reimbursement costs did, as did cost and postoperative clinical status ( r = −0.72). Preoperative cost was a predictive factor for postoperative clinical result. Discussion TDR achieves favorable medicoeconomic results. Level of evidence III: case-control study.