STUDY DESIGN: Cost-effectiveness analysis of a randomized plus observational cohort trial. OBJECTIVE: Analyze cost-effectiveness of Spine Patient Outcomes Research Trial data over 4 years comparing surgery with nonoperative care for three common diagnoses: spinal stenosis (SPS), degenerative spondylolisthesis (DS), and intervertebral disc herniation (IDH). SUMMARY OF BACKGROUND DATA: Spine surgery rates continue to rise in the United States, but the safety and economic value of these procedures remain uncertain. METHODS:Patients with image-confirmed diagnoses were followed in randomized or observational cohorts with data on resource use, productivity, and EuroQol EQ-5D health state values measured at 6 weeks, 3, 6, 12, 24, 36, and 48 months. For each diagnosis, cost per quality-adjusted life year (QALY) gained in 2004 US dollars was estimated for surgery relative to nonoperative care using a societal perspective, with costs and QALYs discounted at 3% per year. RESULTS: Surgery was performed initially or during the 4-year follow-up among 414 of 634 (65.3%) SPS, 391 of 601 (65.1%) DS, and 789 of 1192 (66.2%) IDH patients. Surgery improved health, with persistent QALY differences observed through 4 years (SPS QALY gain 0.22; 95% confidence interval, CI: 0.15, 0.34; DS QALY gain 0.34, 95% CI: 0.30, 0.47; and IDH QALY gain 0.34, 95% CI: 0.31, 0.38). Costs per QALY gained decreased for SPS from $77,600 at 2 years to $59,400 (95% CI: $37,059, $125,162) at 4 years, for DS from $115,600 to $64,300 per QALY (95% CI: $32,864, $83,117), and for IDH from $34,355 to $20,600 per QALY (95% CI: $4,539, $33,088). CONCLUSION: Comparative effectiveness evidence for clearly defined diagnostic groups from Spine Patient Outcomes Research Trial shows good value for surgery compared with nonoperative care over 4 years.
RCT Entities:
STUDY DESIGN: Cost-effectiveness analysis of a randomized plus observational cohort trial. OBJECTIVE: Analyze cost-effectiveness of Spine Patient Outcomes Research Trial data over 4 years comparing surgery with nonoperative care for three common diagnoses: spinal stenosis (SPS), degenerative spondylolisthesis (DS), and intervertebral disc herniation (IDH). SUMMARY OF BACKGROUND DATA: Spine surgery rates continue to rise in the United States, but the safety and economic value of these procedures remain uncertain. METHODS:Patients with image-confirmed diagnoses were followed in randomized or observational cohorts with data on resource use, productivity, and EuroQol EQ-5D health state values measured at 6 weeks, 3, 6, 12, 24, 36, and 48 months. For each diagnosis, cost per quality-adjusted life year (QALY) gained in 2004 US dollars was estimated for surgery relative to nonoperative care using a societal perspective, with costs and QALYs discounted at 3% per year. RESULTS: Surgery was performed initially or during the 4-year follow-up among 414 of 634 (65.3%) SPS, 391 of 601 (65.1%) DS, and 789 of 1192 (66.2%) IDH patients. Surgery improved health, with persistent QALY differences observed through 4 years (SPS QALY gain 0.22; 95% confidence interval, CI: 0.15, 0.34; DS QALY gain 0.34, 95% CI: 0.30, 0.47; and IDH QALY gain 0.34, 95% CI: 0.31, 0.38). Costs per QALY gained decreased for SPS from $77,600 at 2 years to $59,400 (95% CI: $37,059, $125,162) at 4 years, for DS from $115,600 to $64,300 per QALY (95% CI: $32,864, $83,117), and for IDH from $34,355 to $20,600 per QALY (95% CI: $4,539, $33,088). CONCLUSION: Comparative effectiveness evidence for clearly defined diagnostic groups from Spine Patient Outcomes Research Trial shows good value for surgery compared with nonoperative care over 4 years.
Authors: James N Weinstein; Jon D Lurie; Tor D Tosteson; Jonathan S Skinner; Brett Hanscom; Anna N A Tosteson; Harry Herkowitz; Jeffrey Fischgrund; Frank P Cammisa; Todd Albert; Richard A Deyo Journal: JAMA Date: 2006-11-22 Impact factor: 56.272
Authors: James N Weinstein; Tor D Tosteson; Jon D Lurie; Anna N A Tosteson; Brett Hanscom; Jonathan S Skinner; William A Abdu; Alan S Hilibrand; Scott D Boden; Richard A Deyo Journal: JAMA Date: 2006-11-22 Impact factor: 56.272
Authors: James N Weinstein; Jon D Lurie; Patrick R Olson; Kristen K Bronner; Elliott S Fisher Journal: Spine (Phila Pa 1976) Date: 2006-11-01 Impact factor: 3.468
Authors: James N Weinstein; Jon D Lurie; Tor D Tosteson; Brett Hanscom; Anna N A Tosteson; Emily A Blood; Nancy J O Birkmeyer; Alan S Hilibrand; Harry Herkowitz; Frank P Cammisa; Todd J Albert; Sanford E Emery; Lawrence G Lenke; William A Abdu; Michael Longley; Thomas J Errico; Serena S Hu Journal: N Engl J Med Date: 2007-05-31 Impact factor: 91.245
Authors: Steven J Atlas; Robert B Keller; Yen A Wu; Richard A Deyo; Daniel E Singer Journal: Spine (Phila Pa 1976) Date: 2005-04-15 Impact factor: 3.468
Authors: S J Atlas; R A Deyo; R B Keller; A M Chapin; D L Patrick; J M Long; D E Singer Journal: Spine (Phila Pa 1976) Date: 1996-08-01 Impact factor: 3.468
Authors: Anna N A Tosteson; Jonathan S Skinner; Tor D Tosteson; Jon D Lurie; Gunnar B Andersson; Sigurd Berven; Margaret R Grove; Brett Hanscom; Emily A Blood; James N Weinstein Journal: Spine (Phila Pa 1976) Date: 2008-09-01 Impact factor: 3.468
Authors: Michael L Pezold; Andrea L Pusic; Wess A Cohen; James P Hollenberg; Zeeshan Butt; David R Flum; Larissa K Temple Journal: JAMA Surg Date: 2016-10-01 Impact factor: 14.766
Authors: Dean A Tripp; Edward Abraham; Maude Lambert; Kate Wagg; Erin Bigney; Eden Daly; Phylicia Verreault; Neil Manson Journal: Qual Life Res Date: 2017-07-20 Impact factor: 4.147
Authors: Giulia Norton; Christine M McDonough; Howard J Cabral; Michael Shwartz; James F Burgess Journal: Spine J Date: 2015-08-14 Impact factor: 4.166