Daniel R Barlow1, Brendan T Higgins, Elissa M Ozanne, Anna N A Tosteson, Adam M Pearson. 1. *Geisel School of Medicine at Dartmouth, Lebanon, NH†Department of Orthopaedic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH‡The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH§Multidisciplinary Clinical Research Center in Musculoskeletal Diseases, Geisel School of Medicine at Dartmouth, Lebanon, NH.
Abstract
STUDY DESIGN: Cost-effectiveness analysis. OBJECTIVE: To examine the cost-effectiveness of operative versus non-operative treatment of type-II odontoid fractures in patients older than 64 years old. SUMMARY OF BACKGROUND DATA: Significant controversy exists regarding the optimum treatment of geriatric patients with type-II odontoid fractures. Operative treatment leads to lower rates of non-union but carries surgical risks. Non-operative treatment does not carry surgical risks but has higher non-union rates. METHODS: A decision-analytic model was created to compare operative and non-operative treatment of type-II odontoid fractures among three age cohorts (65-74, 75-84, >84) based on expected costs, quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs; cost per QALY gained). Age-specific mortality rates for both treatments, costs for treatment, and complication rates were taken from the literature, and data from 2010 US life tables were used for age-specific life expectancy. Costs of complications were estimated using data obtained at a level-I trauma center using micro-costing. Sensitivity analyses of all model parameters were conducted. RESULTS: Among the 65- to 74-year-old cohort, operative treatment was more costly ($53,407 vs. $30,553) and more effective (12.00 vs. 10.11 QALY), with an ICER of $12,078/QALY. Among the 75- to 84-year-old cohort, operative treatment was more costly ($51,308 vs. $29,789) and more effective (6.85 vs. 6.31 QALY), with an ICER of $40,467/QALY. Among the over-84 cohort, operative treatment was dominated by non-operative treatment as it was both more costly ($45,978 vs. $28,872) and less effective (2.48 vs. 3.73 QALY). The model was robust to sensitivity analysis across reasonable ranges for utility of union, disutility of complications and delayed surgery, and probabilities of non-union and complications. CONCLUSION: Operative treatment is cost-effective in patients age 65 to 84 when using $100,000/QALY as a benchmark but less effective and more costly than non-operative treatment in patients older than 84 years. LEVEL OF EVIDENCE: 2.
STUDY DESIGN: Cost-effectiveness analysis. OBJECTIVE: To examine the cost-effectiveness of operative versus non-operative treatment of type-II odontoid fractures in patients older than 64 years old. SUMMARY OF BACKGROUND DATA: Significant controversy exists regarding the optimum treatment of geriatric patients with type-II odontoid fractures. Operative treatment leads to lower rates of non-union but carries surgical risks. Non-operative treatment does not carry surgical risks but has higher non-union rates. METHODS: A decision-analytic model was created to compare operative and non-operative treatment of type-II odontoid fractures among three age cohorts (65-74, 75-84, >84) based on expected costs, quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs; cost per QALY gained). Age-specific mortality rates for both treatments, costs for treatment, and complication rates were taken from the literature, and data from 2010 US life tables were used for age-specific life expectancy. Costs of complications were estimated using data obtained at a level-I trauma center using micro-costing. Sensitivity analyses of all model parameters were conducted. RESULTS: Among the 65- to 74-year-old cohort, operative treatment was more costly ($53,407 vs. $30,553) and more effective (12.00 vs. 10.11 QALY), with an ICER of $12,078/QALY. Among the 75- to 84-year-old cohort, operative treatment was more costly ($51,308 vs. $29,789) and more effective (6.85 vs. 6.31 QALY), with an ICER of $40,467/QALY. Among the over-84 cohort, operative treatment was dominated by non-operative treatment as it was both more costly ($45,978 vs. $28,872) and less effective (2.48 vs. 3.73 QALY). The model was robust to sensitivity analysis across reasonable ranges for utility of union, disutility of complications and delayed surgery, and probabilities of non-union and complications. CONCLUSION: Operative treatment is cost-effective in patients age 65 to 84 when using $100,000/QALY as a benchmark but less effective and more costly than non-operative treatment in patients older than 84 years. LEVEL OF EVIDENCE: 2.
Authors: Kouta Ito; William H Shrank; Jerry Avorn; Amanda R Patrick; Troyen A Brennan; Elliot M Antman; Niteesh K Choudhry Journal: Health Serv Res Date: 2012-09-21 Impact factor: 3.402
Authors: Justin S Smith; Christopher K Kepler; Branko Kopjar; James S Harrop; Paul Arnold; Jens R Chapman; Michael G Fehlings; Alexander R Vaccaro; Christopher I Shaffrey Journal: Spine (Phila Pa 1976) Date: 2013-12-15 Impact factor: 3.468
Authors: Stéphane Rinfret; David J Cohen; Gervasio A Lamas; Kirsten E Fleischmann; Milton C Weinstein; John Orav; Eleanor Schron; Kerry L Lee; Lee Goldman Journal: Circulation Date: 2005-01-03 Impact factor: 29.690
Authors: Rianne Oostenbrink; Jan B Oostenbrink; Karel G M Moons; Gerarda Derksen-Lubsen; Marie-Louise Essink-Bot; Diederick E Grobbee; W Ken Redekop; Henriëtte A Moll Journal: Int J Technol Assess Health Care Date: 2002 Impact factor: 2.188
Authors: Francis J Jareczek; Kingsley O Abode-Iyamah; Efrem M Cox; Nader S Dahdaleh; Patrick W Hitchon; Matthew A Howard Journal: Oper Neurosurg (Hagerstown) Date: 2017-12-01 Impact factor: 2.703
Authors: Noah L Lessing; Scott L Zuckerman; Albert Lazaro; Ashley A Leech; Andreas Leidinger; Nicephorus Rutabasibwa; Hamisi K Shabani; Halinder S Mangat; Roger Härtl Journal: Global Spine J Date: 2020-08-17