Cost Effectiveness of Chemonucleolysis Versus Laminectomy in the Treatment of Herniated Nucleus Pulposus

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Abstract
The hospital and professional charges for 40 consecutive patients who underwent chymopapain chemonucleolysis in 1982–83 at the University of Wisconsin for single-level lumbar disc disease were compared with the charges incurred by 40 consecutive patients who underwent lumbar laminectomy for single-level disc disease during the same period. The average cost per patient was $4,163 for chemonucleolysis and $6,124 for laminectomy. Three chemonucleolysis patients reported poor results, and all subsequently underwent reoperation by laminectomy. Four laminectomy patients reported poor results, and two of these subsequently underwent reoperation. The costs of chemonucleolysis and lumbar laminectomy were calculated to reflect reoperation costs, and we found that the average cost per patient was $1,808 less for chemonucleolysis. The implications of this saving for national cost containment of lumbar disc surgery are discussed.