Re: AANS/CNS Comments on Draft Technical Assessment for Washington State HTA Rereview of Lumbar Spinal Fusion
Dear Mr. Morse:
On behalf of the American Association of Neurological Surgeons (AANS), the Congress of
Neurological Surgeons (CNS), the AANS/CNS Joint Section on Disorders of the Spine and
Peripheral Nerves, and the Washington State Association of Neurological Surgeons
(WSANS), we appreciate the opportunity to provide comments regarding the draft evidence
assessment prepared for the Washington State Healthcare Authority (WCA) Health
Technology Assessment (HTA) program re-review of coverage policy for lumbar spinal
fusion for degenerative disc disease (DDD). We have provided the following remarks based
on our study of the draft report. We add these comments to those that we submitted in
our letter May 20, 2015 regarding the draft Key Questions used for the report. We look
forward to publication of the final report and to the discussion by the Health Technology
Clinical Committee (HTCC) on November 20, 2015.
Cited Literature Does Not Warrant a Policy Change
The document prepared by the Institute for Clinical and Economic Review (ICER) is a
thorough review of the literature. However, as we stated when the HTA program first
suggested that the 2008 HTA Lumbar Fusion for DDD coverage policy be revisited, we do
not believe that there is a substantial change in evidence for this procedure and we do not
support a change to the current policy, which was based on significant stakeholder input
and a robust review by the HTCC. Nevertheless, we would like to provide the following
commentary on various aspects of the ICER report.
Clarification that the Scope for the Report is for Uncomplicated DDD Only
The key questions for the report are specific to the treatment of chronic low back pain and
uncomplicated DDD. As such, the title of the draft report is slightly misleading as it gives
the impression that it pertains to all lumbar fusions, and not the specific disease entity of
chronic low back pain and uncomplicated DDD. ICER should clarify this in the title of the
final report. The focus of the HTCC meeting discussion should be limited to the specific
topic of chronic low back pain and uncomplicated DDD.
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Read full letter here
