PURPOSE: Palliative surgery for patients with spinal metastasis provides good clinical outcomes. However, there have been few studies on quality of life (QOL) and cost-utility of this surgery. We aimed to elucidate QOL and cost-utility of surgical treatment for spinal metastasis. METHODS: We prospectively analyzed 47 patients with spinal metastasis from 2010 to 2014 who had a surgical indication. Thirty-one patients who desired surgery underwent spinal surgery (surgery group). Sixteen patients who did not want to undergo spinal surgery (non-surgery group). The EuroQol 5D (EQ-5D) and relevant costs were measured at one, three, six, and 12 months after study enrollment. Health state values were obtained by Japanese EQ-5D scoring and quality-adjusted life years (QALY) gained were calculated for each group. Cost-utility was expressed as the incremental cost-utility ratio (ICUR). RESULTS: Health state values improved from 0.036 at study enrollment to 0.448 at 12 months in the surgery group, but deteriorated from 0.056 to 0.019 in the non-surgery group, with a significant difference between groups (P < 0.05). The mean QALY gained at 12 months were 0.433 in the surgery group and 0.024 in the non-surgery group. The mean total cost per patient in the surgery group was $25,770 compared with $8615 in the non-surgery group. The ICUR using oneyear follow-up data was $42,003/QALY gained. CONCLUSIONS: Surgical treatment for spinal metastases is associated with significant improvement in health state value. In orthopaedic surgery, an ICUR less than $50,000/QALY gained is considered acceptable cost-effectiveness. Our results indicate that surgical treatment could be cost-effective.
PURPOSE: Palliative surgery for patients with spinal metastasis provides good clinical outcomes. However, there have been few studies on quality of life (QOL) and cost-utility of this surgery. We aimed to elucidate QOL and cost-utility of surgical treatment for spinal metastasis. METHODS: We prospectively analyzed 47 patients with spinal metastasis from 2010 to 2014 who had a surgical indication. Thirty-one patients who desired surgery underwent spinal surgery (surgery group). Sixteen patients who did not want to undergo spinal surgery (non-surgery group). The EuroQol 5D (EQ-5D) and relevant costs were measured at one, three, six, and 12 months after study enrollment. Health state values were obtained by Japanese EQ-5D scoring and quality-adjusted life years (QALY) gained were calculated for each group. Cost-utility was expressed as the incremental cost-utility ratio (ICUR). RESULTS: Health state values improved from 0.036 at study enrollment to 0.448 at 12 months in the surgery group, but deteriorated from 0.056 to 0.019 in the non-surgery group, with a significant difference between groups (P < 0.05). The mean QALY gained at 12 months were 0.433 in the surgery group and 0.024 in the non-surgery group. The mean total cost per patient in the surgery group was $25,770 compared with $8615 in the non-surgery group. The ICUR using oneyear follow-up data was $42,003/QALY gained. CONCLUSIONS: Surgical treatment for spinal metastases is associated with significant improvement in health state value. In orthopaedic surgery, an ICUR less than $50,000/QALY gained is considered acceptable cost-effectiveness. Our results indicate that surgical treatment could be cost-effective.
Entities:
Keywords:
Cost effective; Cost-utility; EuroQol 5D; Incremental cost-utility ratio; Quality of life; Quality-adjusted life years; Spinal metastasis; Surgical treatment
Authors: Anna N A Tosteson; Jon D Lurie; Tor D Tosteson; Jonathan S Skinner; Harry Herkowitz; Todd Albert; Scott D Boden; Keith Bridwell; Michael Longley; Gunnar B Andersson; Emily A Blood; Margaret R Grove; James N Weinstein Journal: Ann Intern Med Date: 2008-12-16 Impact factor: 25.391
Authors: Grace X Xiong; Miles W A Fisher; Joseph H Schwab; Andrew K Simpson; Lananh Nguyen; Daniel G Tobert; Tracy A Balboni; John H Shin; Marco L Ferrone; Andrew J Schoenfeld Journal: Spine (Phila Pa 1976) Date: 2022-04-01 Impact factor: 3.468
Authors: Tamás Mezei; Anna Horváth; Péter Pollner; Gábor Czigléczki; Péter Banczerowski Journal: Int J Clin Oncol Date: 2020-01-28 Impact factor: 3.402
Authors: Andrew J Schoenfeld; Gordon P Bensen; Justin A Blucher; Marco L Ferrone; Tracy A Balboni; Joseph H Schwab; Mitchel B Harris; Jeffrey N Katz; Elena Losina Journal: J Bone Joint Surg Am Date: 2021-07-21 Impact factor: 5.284
Authors: Andrew J Schoenfeld; Caleb M Yeung; Daniel G Tobert; Lananh Nguyen; Peter G Passias; John H Shin; James D Kang; Marco L Ferrone Journal: Spine (Phila Pa 1976) Date: 2022-01-15 Impact factor: 3.241