{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T06:07:39Z","timestamp":1775628459242,"version":"3.50.1"},"reference-count":21,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,3,26]],"date-time":"2021-03-26T00:00:00Z","timestamp":1616716800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2021,3,26]],"date-time":"2021-03-26T00:00:00Z","timestamp":1616716800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Cost Eff Resour Alloc"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Microdiscectomy is the most commonly performed spine surgery and the first transitioning for outpatient settings. However, this transition was never studied, in what comes to cost-utility assessment. Accordingly, this economic study aims to access the cost-effectiveness of outpatient lumbar microdiscectomy when compared with the inpatient procedure.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>This is a cost utility study, adopting the hospital perspective. Direct medical costs were retrieved from the assessment of 20 patients undergoing outpatient lumbar microdiscectomy and 20 undergoing inpatient lumbar microdiscectomy Quality-adjusted life-years were calculated from Oswestry Disability Index values (ODI). ODI was prospectively assessed in outpatients in pre and 3- and 6-month post-operative evaluations. Inpatient ODI data were estimated from a meta-analysis. A probabilistic sensitivity analysis was performed and incremental cost-effectiveness ratio (ICER) calculated.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Outpatient procedure was cost-saving in all models tested. At 3-month assessment ICER ranged from \u20ac135,753 to \u20ac345,755\/QALY, higher than the predefined threshold of \u20ac60,000\/QALY gained. At 6-month costs were lower and utilities were higher in outpatient, overpowering the inpatient procedure. Probabilistic sensitivity analysis showed that in 65% to 73% of simulations outpatient was the better option. The savings with outpatient were about 55% of inpatient values, with similar utility scores. No 30-day readmissions were recorded in either group.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>This is the first economic study on cost-effectiveness of outpatient lumbar microdiscectomy, showing a significant reduction in costs, with a similar clinical outcome, proving it cost-effective.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12962-021-00272-w","type":"journal-article","created":{"date-parts":[[2021,3,26]],"date-time":"2021-03-26T14:02:52Z","timestamp":1616767372000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Cost effectiveness of outpatient lumbar discectomy"],"prefix":"10.1186","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7398-0626","authenticated-orcid":false,"given":"Daniela","family":"Linhares","sequence":"first","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0887-8796","authenticated-orcid":false,"given":"Jo\u00e3o A.","family":"Fonseca","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7520-2385","authenticated-orcid":false,"given":"Manuel","family":"Ribeiro da Silva","sequence":"additional","affiliation":[]},{"given":"Filipe","family":"Concei\u00e7\u00e3o","sequence":"additional","affiliation":[]},{"given":"Ant\u00f3nio","family":"Sousa","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1277-3401","authenticated-orcid":false,"given":"Bernardo","family":"Sousa-Pinto","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5413-435X","authenticated-orcid":false,"given":"Nuno","family":"Neves","sequence":"additional","affiliation":[]}],"member":"297","published-online":{"date-parts":[[2021,3,26]]},"reference":[{"issue":"4","key":"272_CR1","doi-asserted-by":"publisher","first-page":"507","DOI":"10.1007\/s12178-017-9441-4","volume":"10","author":"RM Amin","year":"2017","unstructured":"Amin RM, Andrade NS, Neuman BJ. Lumbar disc herniation. Curr Rev Musculoskelet Med. 2017;10(4):507\u201316.","journal-title":"Curr Rev Musculoskelet Med"},{"issue":"2","key":"272_CR2","doi-asserted-by":"publisher","first-page":"E1","DOI":"10.3171\/foc.2002.13.2.2","volume":"13","author":"MD Martin","year":"2002","unstructured":"Martin MD, Boxell CM, Malone DG. Pathophysiology of lumbar disc degeneration: a review of the literature. Neurosurg Focus. 2002;13(2):E1.","journal-title":"Neurosurg Focus"},{"issue":"9","key":"272_CR3","doi-asserted-by":"publisher","first-page":"487","DOI":"10.1007\/BF02600110","volume":"8","author":"RM Hoffman","year":"1993","unstructured":"Hoffman RM, Wheeler KJ, Deyo RA. Surgery for herniated lumbar discs: a literature synthesis. J Gen Intern Med. 1993;8(9):487\u201396.","journal-title":"J Gen Intern Med"},{"issue":"17","key":"272_CR4","doi-asserted-by":"publisher","first-page":"1957","DOI":"10.1097\/01.brs.0000229148.63418.c1","volume":"31","author":"DT Gray","year":"2006","unstructured":"Gray DT, Deyo RA, Kreuter W, Mirza SK, Heagerty PJ, Comstock BA, et al. Population-based trends in volumes and rates of ambulatory lumbar spine surgery. Spine (Phila Pa 1976). 2006;31(17):1957\u201363 (discussion 64).","journal-title":"Spine (Phila Pa 1976)."},{"key":"272_CR5","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD010328.pub2","author":"MR Rasouli","year":"2014","unstructured":"Rasouli MR, Rahimi-Movaghar V, Shokraneh F, Moradi-Lakeh M, Chou R. Minimally invasive discectomy versus microdiscectomy\/open discectomy for symptomatic lumbar disc herniation. Cochrane Database Syst Rev. 2014. https:\/\/doi.org\/10.1002\/14651858.CD010328.pub2.","journal-title":"Cochrane Database Syst Rev."},{"issue":"7","key":"272_CR6","doi-asserted-by":"publisher","first-page":"1162","DOI":"10.1016\/j.spinee.2019.02.003","volume":"19","author":"KC Choi","year":"2019","unstructured":"Choi KC, Shim HK, Kim JS, Cha KH, Lee DC, Kim ER, et al. Cost-effectiveness of microdiscectomy versus endoscopic discectomy for lumbar disc herniation. Spine J. 2019;19(7):1162\u20139.","journal-title":"Spine J"},{"issue":"2","key":"272_CR7","doi-asserted-by":"publisher","first-page":"E3","DOI":"10.3171\/foc.2002.13.2.4","volume":"13","author":"CJ Koebbe","year":"2002","unstructured":"Koebbe CJ, Maroon JC, Abla A, El-Kadi H, Bost J. Lumbar microdiscectomy: a historical perspective and current technical considerations. Neurosurg Focus. 2002;13(2):E3.","journal-title":"Neurosurg Focus"},{"issue":"9","key":"272_CR8","doi-asserted-by":"publisher","first-page":"1048","DOI":"10.1097\/00007632-199605010-00011","volume":"21","author":"AD Malter","year":"1996","unstructured":"Malter AD, Larson EB, Urban N, Deyo RA. Cost-effectiveness of lumbar discectomy for the treatment of herniated intervertebral disc. Spine (Phila Pa 1976). 1996;21(9):1048\u201354 (discussion 55).","journal-title":"Spine (Phila Pa 1976)."},{"issue":"8","key":"272_CR9","doi-asserted-by":"publisher","first-page":"1698","DOI":"10.1007\/s00586-018-5513-4","volume":"27","author":"K Kobayashi","year":"2018","unstructured":"Kobayashi K, Ando K, Nishida Y, Ishiguro N, Imagama S. Epidemiological trends in spine surgery over 10 years in a multicenter database. Eur Spine J. 2018;27(8):1698\u2013703.","journal-title":"Eur Spine J"},{"key":"272_CR10","unstructured":"World Health Organization. Regional Office for E, European Observatory on Health S, Policies, Castoro C, Bertinato L, Baccaglini U, et al. Day surgery: making it happen. Copenhagen: World Health Organization. Regional Office for Europe; 2007."},{"issue":"5","key":"272_CR11","doi-asserted-by":"publisher","first-page":"E11","DOI":"10.3171\/2018.2.FOCUS17790","volume":"44","author":"AV Pendharkar","year":"2018","unstructured":"Pendharkar AV, Shahin MN, Ho AL, Sussman ES, Purger DA, Veeravagu A, et al. Outpatient spine surgery: defining the outcomes, value, and barriers to implementation. Neurosurg Focus. 2018;44(5):E11.","journal-title":"Neurosurg Focus"},{"key":"272_CR12","doi-asserted-by":"crossref","unstructured":"Fjeld OR, Gr\u00f8vle L, Helgeland J, Sm\u00e5stuen MC, Solberg TK, Zwart JA, et al. Complications, reoperations, readmissions, and length of hospital stay in 34 639 surgical cases of lumbar disc herniation. Bone Joint J. 2019;101-B(4):470\u20137.","DOI":"10.1302\/0301-620X.101B4.BJJ-2018-1184.R1"},{"issue":"7","key":"272_CR13","doi-asserted-by":"publisher","first-page":"1660","DOI":"10.1007\/s00586-019-06272-y","volume":"29","author":"A Rushton","year":"2020","unstructured":"Rushton A, Heneghan NR, Heymans MW, Staal JB, Goodwin P. Clinical course of pain and disability following primary lumbar discectomy: systematic review and meta-analysis. Eur Spine J. 2020;29(7):1660\u201370.","journal-title":"Eur Spine J"},{"issue":"5","key":"272_CR14","doi-asserted-by":"publisher","first-page":"487","DOI":"10.1002\/hec.944","volume":"14","author":"A Manca","year":"2005","unstructured":"Manca A, Hawkins N, Sculpher MJ. Estimating mean QALYs in trial-based cost-effectiveness analysis: the importance of controlling for baseline utility. Health Econ. 2005;14(5):487\u201396.","journal-title":"Health Econ"},{"key":"272_CR15","unstructured":"Macroeconomics and health: investing in health for economic development ; report of the Commission on Macroeconomics and Health. Geneva: WHO; 2001."},{"key":"272_CR16","volume-title":"World economic outlook","author":"Fund IM","year":"1980","unstructured":"Fund IM. World economic outlook. Washington, DC: International Monetary Fund; 1980."},{"issue":"391\u2013407","key":"272_CR17","first-page":"e2","volume":"114","author":"MA Alvi","year":"2018","unstructured":"Alvi MA, Kerezoudis P, Wahood W, Goyal A, Bydon M. Operative approaches for lumbar disc herniation: a systematic review and multiple treatment meta-analysis of conventional and minimally invasive surgeries. World Neurosurg. 2018;114(391\u2013407):e2.","journal-title":"World Neurosurg"},{"issue":"Suppl 2","key":"272_CR18","first-page":"21","volume":"88","author":"JN Katz","year":"2006","unstructured":"Katz JN. Lumbar disc disorders and low-back pain: socioeconomic factors and consequences. J Bone Joint Surg Am. 2006;88(Suppl 2):21\u20134.","journal-title":"J Bone Joint Surg Am"},{"key":"272_CR19","unstructured":"Rosinsky PJ, Go CC, Bheem R, Shapira J, Maldonado DR, Meghpara MB, et al. The cost-effectiveness of outpatient surgery for primary total hip arthroplasty in the United States: a computer-based cost-utility study. HIP International. 1120700020952776."},{"issue":"4","key":"272_CR20","doi-asserted-by":"publisher","first-page":"6177","DOI":"10.4081\/or.2015.6177","volume":"7","author":"DC Crawford","year":"2015","unstructured":"Crawford DC, Li CS, Sprague S, Bhandari M. Clinical and cost implications of inpatient versus outpatient orthopedic surgeries: a systematic review of the published literature. Orthop Rev (Pavia). 2015;7(4):6177.","journal-title":"Orthop Rev (Pavia)."},{"issue":"1","key":"272_CR21","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1186\/1472-6963-6-6","volume":"6","author":"A Earnest","year":"2006","unstructured":"Earnest A, Chen MIC, Seow E. Exploring if day and time of admission is associated with average length of stay among inpatients from a tertiary hospital in Singapore: an analytic study based on routine admission data. BMC Health Serv Res. 2006;6(1):6.","journal-title":"BMC Health Serv Res"}],"container-title":["Cost Effectiveness and Resource Allocation"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12962-021-00272-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/s12962-021-00272-w\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12962-021-00272-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,3,26]],"date-time":"2021-03-26T14:03:27Z","timestamp":1616767407000},"score":1,"resource":{"primary":{"URL":"https:\/\/resource-allocation.biomedcentral.com\/articles\/10.1186\/s12962-021-00272-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,26]]},"references-count":21,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["272"],"URL":"https:\/\/doi.org\/10.1186\/s12962-021-00272-w","relation":{},"ISSN":["1478-7547"],"issn-type":[{"value":"1478-7547","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,3,26]]},"assertion":[{"value":"25 January 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 March 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 March 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was approved by a Portuguese hospital ethics committee in May 2017. Written informed consent was obtained from all individual participants included in the study.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and Consent to participate"}},{"value":"Written informed consent was obtained from all individual participants included in the study for publication of their anonymized data.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to publish"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"19"}}