Bart Depreitere1, Isobel Turner2, Cindy Vandoren3, David Choi2. 1. Division of Neurosurgery, University Hospitals Leuven, Leuven, Belgium. Electronic address: bart.depreitere@uzleuven.be. 2. Neurosurgical Department, National Hospital for Neurology and Neurosurgery, Queen Square, London, England. 3. Management Information and Reporting, University Hospitals Leuven, Leuven, Belgium.
Abstract
OBJECTIVE: Spinal metastases represent the most common site of bony metastases and frequently reduce quality of life. A beneficial effect of surgery and radiotherapy versus radiotherapy alone has been demonstrated in symptomatic patients. The goal of our study was to perform a cost-utility analysis of surgery for spinal metastases based on patient-level costs and health status data in a specialist spine center in Belgium. METHODS: A cost-utility analysis was performed in a prospective cohort of patients undergoing surgery for symptomatic spinal metastases in 2011-2015. EQ-5D-3L measure of health-related quality of life data were collected preoperatively and at 3, 6, 12, and 24 months. Hospital costs relating to surgical management including postoperative radiotherapy were analyzed. A retrospective cohort of patients treated with radiotherapy alone between 2011 and 2015, which matched the surgical patients for disease load and presentation, also was assessed. Quality-adjusted life years (QALYs) for nonsurgical patients were modelled against the surgical group. RESULTS: In total, 38 consecutive surgical patients had information for cost-utility analysis and 8 nonsurgical patients were matched. Mean total cost in the surgical group was €16,989 (SD €8148), largely comprising nonmedical staffing cost (mean €7721, 45.9%), followed by daily operational costs (€2963, 17.6%) and medical staffing costs (€2621, 15.6%). Median initial health status was 0.33 (interquartile range 0.15-0.55), and median postoperative QALYs were 0.70 (interquartile range 0.18-1.70). Mean total cost in the nonsurgical cohort was €9354. The incremental cost-effectiveness ratio for surgical management was €13,635 (range €12,726-€14,407) per QALY. CONCLUSIONS: Surgery for symptomatic spinal metastases in a specialist hospital in Belgium is cost-effective.
OBJECTIVE:Spinal metastases represent the most common site of bony metastases and frequently reduce quality of life. A beneficial effect of surgery and radiotherapy versus radiotherapy alone has been demonstrated in symptomatic patients. The goal of our study was to perform a cost-utility analysis of surgery for spinal metastases based on patient-level costs and health status data in a specialist spine center in Belgium. METHODS: A cost-utility analysis was performed in a prospective cohort of patients undergoing surgery for symptomatic spinal metastases in 2011-2015. EQ-5D-3L measure of health-related quality of life data were collected preoperatively and at 3, 6, 12, and 24 months. Hospital costs relating to surgical management including postoperative radiotherapy were analyzed. A retrospective cohort of patients treated with radiotherapy alone between 2011 and 2015, which matched the surgical patients for disease load and presentation, also was assessed. Quality-adjusted life years (QALYs) for nonsurgical patients were modelled against the surgical group. RESULTS: In total, 38 consecutive surgical patients had information for cost-utility analysis and 8 nonsurgical patients were matched. Mean total cost in the surgical group was €16,989 (SD €8148), largely comprising nonmedical staffing cost (mean €7721, 45.9%), followed by daily operational costs (€2963, 17.6%) and medical staffing costs (€2621, 15.6%). Median initial health status was 0.33 (interquartile range 0.15-0.55), and median postoperative QALYs were 0.70 (interquartile range 0.18-1.70). Mean total cost in the nonsurgical cohort was €9354. The incremental cost-effectiveness ratio for surgical management was €13,635 (range €12,726-€14,407) per QALY. CONCLUSIONS: Surgery for symptomatic spinal metastases in a specialist hospital in Belgium is cost-effective.
Authors: Andrew J Schoenfeld; Marco L Ferrone; Justin A Blucher; Nicole Agaronnik; Lananh Nguyen; Daniel G Tobert; Tracy A Balboni; Joseph H Schwab; John H Shin; Daniel M Sciubba; Mitchel B Harris Journal: Spine J Date: 2021-03-16 Impact factor: 4.166
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: 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