***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: BACKGROUND CONTEXT Laminectomy for lumbar stenosis-associated radiculopathy is associated with improvement in pain , disability , and quality of life . However , given rising health-care costs , attention has been turned to question the cost-effectiveness of lumbar decompressive procedures . The cost-effectiveness of multilevel hemilaminectomy for radiculopathy remains unclear . PURPOSE To assess the comprehensive medical and societal costs of multilevel hemilaminectomy at our institution and determine its cost-effectiveness in the treatment of degenerative lumbar stenosis . STUDY DESIGN Prospect i ve single cohort study . PATIENT SAMPLE Fifty-four consecutive patients undergoing multilevel hemilaminectomy for lumbar stenosis-associated radiculopathy after at least 6 months of failed conservative therapy were included . OUTCOME MEASURES Self-reported measures were assessed using an outcomes question naire that incorporated total back-related medical re source utilization , missed work , and improvement in leg pain ( visual analog scale for leg pain [ VAS-LP ] ) , disability ( Oswestry Disability Index [ ODI ] ) , quality of life ( Short Form-12 [ SF-12 ] ) , and health state values ( quality -adjusted life years [ QALYs ] , calculated from EuroQuol 5D [ EQ-5D ] with US valuation ) . METHODS Over a 2-year period , total back-related medical re source utilization , missed work , and improvement in leg pain ( VAS-LP ) , disability ( ODI ) , quality of life ( SF-12 ) , and health state values ( QALYs , calculated from EQ-5D with US valuation ) were assessed . Two-year re source use was multiplied by unit costs based on Medicare national allowable payment amounts ( direct cost ) , and patient and caregiver workday losses were multiplied by the self-reported gross-of-tax wage rate ( indirect cost ) . Mean total 2-year cost per QALY gained after multilevel hemilaminectomy was assessed . RESULTS Compared with preoperative health states reported after at least 6 months of medical management , a significant improvement in VAS-LP , ODI , and SF-12 ( physical and mental components ) was observed 2 years after multilevel hemilaminectomy , with a mean 2-year gain of 0.72 QALYs . Mean±st and ard deviation total 2-year  cost of multilevel hemilaminectomy was $ 24,264±10,319 ( surgery cost , $ 10,220±80.57 ; outpatient re source utilization cost , $ 3,592±3,243 ; and indirect cost , $ 10,452±9,364 ) . Multilevel hemilaminectomy was associated with a mean 2-year cost per QALY gained of $ 33,700 . CONCLUSIONS Multilevel hemilaminectomy  improved pain , disability , and quality of life in patients with lumbar stenosis-associated radiculopathy . Total cost per QALY gained for multilevel hemilaminectomy was $ 33,700 when evaluated 2 years after surgery with Medicare fees , suggesting that multilevel hemilaminectomy is a cost-effective treatment of lumbar radiculopathy BACKGROUND The SPORT ( Spine Patient Outcomes Research Trial ) reported favorable surgery outcomes over 2 years among patients with stenosis with and without degenerative spondylolisthesis , but the economic value of these surgeries is uncertain . OBJECTIVE To assess the short-term cost-effectiveness of spine surgery relative to nonoperative care for stenosis alone and for stenosis with spondylolisthesis . DESIGN Prospect i ve cohort study . DATA SOURCES Re source utilization , productivity , and EuroQol EQ-5D score measured at 6 weeks and at 3 , 6 , 12 , and 24 months after treatment among SPORT participants . TARGET POPULATION Patients with image-confirmed spinal stenosis , with and without degenerative spondylolisthesis . TIME HORIZON 2 years . PERSPECTIVE Societal . INTERVENTION Nonoperative care or surgery ( primarily decompressive laminectomy for stenosis and decompressive laminectomy with fusion for stenosis associated with degenerative spondylolisthesis ) . OUTCOME MEASURES Cost per quality -adjusted life-year ( QALY ) gained . RESULTS OF BASE-CASE ANALYSIS Among 634 patients with stenosis , 394 ( 62 % ) had surgery , most often decompressive laminectomy ( 320 of 394 [ 81 % ] ) . Stenosis surgeries improved health to a greater extent than nonoperative care ( QALY gain , 0.17 [ 95 % CI , 0.12 to 0.22 ] ) at a cost of $ 77,600 ( CI , $ 49,600 to $ 120,000 ) per QALY gained . Among 601 patients with degenerative spondylolisthesis , 368 ( 61 % ) had surgery , most including fusion ( 344 of 368 [ 93 % ] ) and most with instrumentation ( 269 of 344 [ 78 % ] ) . Degenerative spondylolisthesis surgeries significantly improved health versus nonoperative care ( QALY gain , 0.23 [ CI , 0.19 to 0.27 ] ) , at a cost of $ 115,600 ( CI , $ 90,800 to $ 144,900 ) per QALY gained . RESULT OF SENSITIVITY ANALYSIS : Surgery cost markedly affected the value of surgery . LIMITATION The study used self-reported utilization data , 2-year time horizon , and as-treated analysis to address treatment nonadherence among r and omly assigned participants . CONCLUSION The economic value of spinal stenosis surgery at 2 years compares favorably with many health interventions . Degenerative spondylolisthesis surgery is not highly cost-effective over 2 years but could show value over a longer time horizon BACKGROUND : Conventional microdiskectomy is the most frequently performed surgery for patients with sciatica caused by lumbar disk herniation .  Transmuscular tubular diskectomy has been introduced to increase the rate of recovery , although evidence of its efficacy is lacking . OBJECTIVE : To determine whether a favorable cost-effectiveness for tubular diskectomy compared with conventional microdiskectomy is attained . METHODS : Cost utility analysis was performed alongside a double-blind r and omized controlled trial conducted among 325 patients with lumbar disk related sciatica lasting > 6 to 8 weeks at 7 Dutch hospitals comparing tubular diskectomy with conventional microdiskectomy .  Main outcome measures were quality -adjusted life-years at 1 year and societal costs , estimated from patient reported utilities ( US and Netherl and s EuroQol , Short Form Health Survey-6D , and Visual Analog Scale ) and diaries on costs ( health care , patient costs , and productivity ) . RESULTS : Quality -adjusted life-years during all 4 quarters and according to all utility measures were not statistically different between tubular diskectomy and conventional microdiskectomy ( difference for US EuroQol , −0.012 ; 95 % confidence interval , −0.046 to 0.021 ) . From the healthcare perspective , tubular diskectomy result ed in nonsignificantly higher costs ( difference US $ 460 ; 95 % confidence interval , −243 to 1163 ) . From the societal perspective , a nonsignificant difference of US $ 1491 ( 95 % confidence interval , −1335 to 4318 ) in favor of conventional microdiskectomy was found . The nonsignificant differences in costs and quality -adjusted life-years in favor of conventional microdiskectomy result in a low probability that tubular diskectomy is more cost-effective  than conventional microdiskectomy . CONCLUSION : Tubular diskectomy is unlikely to be cost-effective compared with conventional microdiskectomy Although there are several accepted methods of surgical treatment for single-level cervical radiculopathy , the choice depend on the surgeon ’s preference . The techniques may vary in peri-operative morbidity , short- and long-term outcome , but no study so far has analyzed their cost-effectiveness . This study might give some insight in balancing cost and effectiveness and deciding the right technique . Sixty consecutive patients ( 15 each group ) , mean age 36 ( range 24–76 years ) with single-level cervical disc disease underwent surgical treatment with four different techniques in two centers over the period of 1999–2005 . The four groups were—(1 ) plate and tricortical autograft , ( 2 ) plate , cage , and bone substitute , ( 3 ) cage only , and ( 4 ) disc arthroplasty . The data was collected prospect ively according to our protocol and subsequently analyzed . The clinical outcome was assessed comparing visual analog scale ( VAS ) of neck pain and , short form 12 ( SF12 ) question naire both pre- and postoperatively . The radiological assessment was done for fusion rate and postoperative related possible complications at 3 months , 6 months , 1 year , and final follow-up . The cost analysis was done calculating the operative time , hospital stay , implant cost together . The mean follow-up period was 31 months ( range 28–43 months ) . The clinical outcome in terms of VAS of neck and arm pain and SF12 physical and mental score improvement ( P = 0.001 ) were comparable with all four techniques . The radiological fusion rate was comparable to current available data . As the hospital stay was longer ( average 5 days ) with plate and autograft group , the total cost was maximum ( average £ 2,920 ) with this group . There was satisfactory clinical and radiological outcome with all four techniques . Using the cage alone was the most cost-effective technique , but the disc arthroplasty was comparable to the use of cage and plate . Anterior cervical discectomy and fusion is an established surgical treatment for cervical radiculopathy . Single-level cervical radiculopathy was treated with four different techniques . The clinical outcome and cost-effectiveness were compared in this study Abstract Objective To determine whether , from a health provider and patient perspective , surgical stabilisation of the spine is cost effective when compared with an intensive programme of rehabilitation in patients with chronic low back pain . Design Economic evaluation alongside a pragmatic r and omised controlled trial . Setting Secondary care . Participants 349 patients r and omised to surgery ( n = 176 ) or to an intensive rehabilitation programme ( n = 173 ) from 15 centres across the United Kingdom between June 1996 and February 2002 . Main outcome measures Costs related to back pain and incurred by the NHS and patients up to 24 months after r and omisation . Return to paid employment and total hours worked . Patient utility as estimated by using the EuroQol EQ-5D question naire at several time points and used to calculate quality adjusted life years ( QALYs ) . Cost effectiveness was expressed as an incremental cost per QALY . Results At two years , 38 patients r and omised to rehabilitation had received rehabilitation and surgery whereas just seven surgery patients had received both treatments . The mean total cost per patient was estimated to be £ 7830 ( SD £ 5202 ) in the surgery group and £ 4526 ( SD £ 4155 ) in the intensive rehabilitation arm , a significant difference of £ 3304 ( 95 % confidence interval £ 2317 to £ 4291 ) . Mean QALYs over the trial period were 1.004 ( SD 0.405 ) in the surgery group and 0.936 ( SD 0.431 ) in the intensive rehabilitation group , giving a non-significant difference of 0.068 ( –0.020 to 0.156 ) . The incremental cost effectiveness ratio was estimated to be £ 48 588 per QALY gained ( –£279 883 to £ 372 406 ) . Conclusion Two year follow-up data show that surgical stabilisation of the spine may not be a cost effective use of scarce healthcare re sources . However , sensitivity analyses show that this could change — for example , if the proportion of rehabilitation patients requiring subsequent surgery continues to increase Background The cost-effectiveness acceptability curve ( CEAC ) is a method for summarizing the uncertainty in estimates of cost-effectiveness . The CEAC , derived from the joint distribution of costs and effects , illustrates the ( Bayesian ) probability that the data are consistent with a true cost-effectiveness ratio falling below a specified ceiling ratio . The objective of the paper is to illustrate how to construct and interpret a CEAC . Methods A retrospective cost-effectiveness analysis of the Atrial Fibrillation Follow-up Investigation of Rhythm Management ( AFFIRM ) r and omized controlled trial with 4060 patients followed for 3.5 years . The target population was patients with atrial fibrillation who were 65 years of age or had other risk factors for stroke or death similar to those enrolled in AFFIRM . The intervention involved the management of patients with atrial fibrillation with antiarrhythmic drugs ( rhythm-control ) compared with drugs that control heart rate ( rate-control ) . Measurements of mean survival , mean costs and incremental cost-effectiveness were made . The uncertainty surrounding the estimates of cost-effectiveness was illustrated through a cost-effectiveness acceptability curve . Results The base case point estimate for the difference in effects and costs between rate and rhythm-control is 0.08 years ( 95 % CI : -0.1 years to 0.24 years ) and -US$5,077 ( 95 % 
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CONCLUSIONS Changes in cost have a direct impact on the value equation for concluding whether an intervention is cost-effective .