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Title: Cost-effectiveness and quality of life after treatment of lumbar spinal stenosis with the interspinous distractor device (X-STOP) or laminectomy : a pilot study
Author: Nurboja, B.
Awarding Body: University College London (University of London)
Current Institution: University College London (University of London)
Date of Award: 2013
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OBJECTIVES: Primary end-point was to assess the cost-effectiveness of lumbar laminectomy versus X-stop insertion in patients with neurogenic claudication secondary to LSS. Secondary end-points were to compare quality of life, clinical outcomes, radiological parameters and complications within two groups. This is a pilot study to produce predictive models and allow sample size calculation. DESIGN: Multicentre randomised trial with two interventional arms, namely the lumbar laminectomy(LL) and X-stop(XS) groups. METHODS: Patients were recruited from two neurosurgical centres after fulfilling eligibility criteria and followed up for 1 year. Self-reported general quality of life and disease-specific questionnaires were used. The assessments were performed at discharge, 6 weeks, 6 and 12 months. Also, radiological parameters were analysed. RESULTS: In this pilot study 26 patients were identified of which 6 were excluded and 20 were randomised with 10 in lumbar laminectomy and 10 in X-stop(XS) group from June 2008 to January 2010. LL group incured lower costs than the XS group but showed no significant between-group differences in utility values (QALYs). We found that LL was perhaps more cost-effective than the XS but with uncertainty, suggesting the need for a larger trial. There were no significant differences between the two groups in quality of life, clinical outcomes or success rates but within group improvements were found. Importantly, 6 out of 10 patients (60%) from XS group crossed over to LL group. Sample size calculation with the original data showed the need for 25 patients in each arm to detect clinical significance in future clinical trial. CONCLUSION: Our results suggest that LL is possibly cheaper and more cost-effective than XS over a 1-year period, in National Health Service. No significant differences in quality of life and clinical outcomes between the two procedures were detected although this is only a pilot study with a small sample size.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available