Special Poster Session 51st International Society for the Study of the Lumbar Spine Annual Meeting 2025

Cost-utility analysis of a pre-, peri- and postoperative rehabilitation pathway versus usual care in patients undergoing lumbar fusion surgery (115729)

Liedewij Bogaert 1 , Olivier Nachtergaele 1 , Tinne Thys 1 , Peter Van Wambeke 1 , Lotte Janssens 2 , Thijs Swinnen 3 , Lieven Moke 4 , Sebastiaan Schelfaut 4 , Joost Dejaegher 5 , Sieglinde Bogaert 6 , Koen Peers 1 , Ann Spriet 1 , Wim Dankaerts 3 , Simon Brumagne 3 , Bart Depreitere 5
  1. Department of Physical and Rehabilitation Medicine, University Hospitals Leuven, Leuven, Belgium
  2. REVAL Rehabilitation Research Center, Hasselt University, Diepenbeek, Belgium
  3. Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
  4. Department of Orthopaedics, University Hospitals Leuven, Leuven, Belgium
  5. Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
  6. Department of Movement Sciences, KU Leuven, Leuven, Belgium

Introduction

Previous research has shown that a pre-, peri- and postoperative rehabilitation pathway for patients undergoing lumbar fusion surgery (i.e. the REACT rehabilitation) is associated with greater improvements in disability, back pain, and return-to-work rates over time, compared to usual care. Understanding the economic implications is essential to justify the potential implementation of the rehabilitation pathway.

The aim of this study was to conduct an economic evaluation of the cost-utility of the REACT rehabilitation compared with usual care for patients undergoing lumbar fusion surgery.

 

Methods

A cost-utility analysis was conducted over a six-month time horizon from the perspective of the Belgian healthcare system. Cost and utility data were derived from the REACT trial. A secondary analysis from a societal perspective included indirect costs associated with productivity losses. A probabilistic sensitivity analysis was performed to assess uncertainty. The primary outcomes were differences in costs, quality-adjusted life years (QALY), and incremental cost-effectiveness ratio (ICER) over the six-month period (ranging from the day before surgery to six months after surgery).

 

Results

The main analysis included 72 patients (mean age 55.1 years [SD 14.1], 59.7% female). The REACT rehabilitation was associated with lower outpatient medical costs (p<0.0001), lower indirect costs (p<0.0001) and a trend towards lower hospitalization costs (p=0.07). However, rehabilitation costs were higher (p=0.002) and no significant improvement in QALYs was observed within six months. The resulting ICER of -87,762.78€/QALY indicated that the REACT rehabilitation was both more effective and less costly than usual care. Probabilistic sensitivity analysis showed that the REACT rehabilitation remained below the willingness-to-pay threshold of one-time Belgian GDP in 92.8% of the simulations. The secondary analysis confirmed the cost-utility of REACT rehabilitation when indirect costs were included. When only direct outpatient and rehabilitation costs were considered, the REACT rehabilitation was associated with higher costs, but the probability of being cost-effective remained high.

 

Discussion

The REACT rehabilitation was cost-effective compared to usual care for patients undergoing lumbar fusion surgery. The REACT rehabilitation seems to be a low-cost intervention. Despite the absence of significant gains in health utility or reductions in direct medical costs, the substantial reductions in indirect costs highlight the economic value of the rehabilitation pathway. This is particularly relevant, as indirect costs were found to exceed direct costs in patients undergoing lumbar fusion surgery.