Steven D Glassman1,2, Leah Y Carreon3, Christopher I Shaffrey4, Michael P Kelly5, Charles H Crawford1,2, Elizabeth L Yanik5, Jon D Lurie6, R Shay Bess7, Christine R Baldus4, Keith H Bridwell4. 1. Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY, 40202, USA. 2. School of Medicine Department of Orthopaedic Surgery, University of Louisville, 550 S. Jackson St., 1st Floor ACB, Louisville, KY, 40202, USA. 3. Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY, 40202, USA. leah.carreon@nortonhealthcare.org. 4. Duke University Duke Spine Center-Clinic 1B/1C, 40 Duke Medicine Circle, Durham, NC, 27710-400, USA. 5. Department of Orthopaedic Surgery, Washington University School of Medicine, 660 S. Euclid Ave, Campus Box 8233, St. Louis, MO, 63110, USA. 6. Departments of Medicine and Orthopaedics, Dartmouth-Hitchcock Medical Center, One Medical Center Dr., Lebanon, NH, 03756, USA. 7. Department of Orthopaedic Surgery, Rocky Mountain Hospital for Children, 1721 E. 19th Ave., Suite 244, Denver, CO, 80218, USA.
Abstract
STUDY DESIGN: Longitudinal comparative cohort. OBJECTIVE: The purpose of this study is to report on the cost-effectiveness of surgical versus non-surgical treatment for Adult Symptomatic Lumbar Scoliosis (ASLS) using the as-treated data and provide a comparison to previously reported intent-to-treat (ITT) analysis. Adult spinal deformity is a relatively prevalent condition for which surgical treatment has become increasingly common but concerns surrounding complications, revision rates and cost-effectiveness remain unresolved. Of these issues, cost-effectiveness is perhaps the most difficult to quantify as the requisite data is difficult to obtain. The purpose of this study is to report on the cost-effectiveness of surgical versus non-surgical treatment for ASLS using the as-treated data and provide a comparison to previously reported ITT analysis. METHODS: Patients with at least 5-year follow-up data within the same treatment arm were included. Data collected every 3 months included use of nonoperative modalities, medications and employment status. Costs for surgeries and non-operative modalities were determined using Medicare Allowable rates. Medication costs were determined using the RedBook and indirect costs were calculated based on the reported employment status and income. Quality-Adjusted Life Years (QALY) was determined using the SF-6D. RESULTS: Of 226 patients, 195 patients (73 Non-op, 122 Op) met inclusion criteria. At 5 years, 29 (24%) patients in the Op group had a revision surgery of whom two had two revisions and one had three revisions. The cumulative cost for the Op group was $111,451 with a cumulative QALY gain of 2.3. The cumulative cost for the Non-Op group was $29,124 with a cumulative QALY gain of 0.4. This results in an ICER of $44,033 in favor of Op treatment. CONCLUSION: This as-treated cost-effectiveness analysis demonstrates that surgical treatment for adult lumbar scoliosis becomes favorable at year-three, 1 year earlier than suggested by a previous intent-to-treat analysis. LEVEL OF EVIDENCE: II.
STUDY DESIGN: Longitudinal comparative cohort. OBJECTIVE: The purpose of this study is to report on the cost-effectiveness of surgical versus non-surgical treatment for Adult Symptomatic Lumbar Scoliosis (ASLS) using the as-treated data and provide a comparison to previously reported intent-to-treat (ITT) analysis. Adult spinal deformity is a relatively prevalent condition for which surgical treatment has become increasingly common but concerns surrounding complications, revision rates and cost-effectiveness remain unresolved. Of these issues, cost-effectiveness is perhaps the most difficult to quantify as the requisite data is difficult to obtain. The purpose of this study is to report on the cost-effectiveness of surgical versus non-surgical treatment for ASLS using the as-treated data and provide a comparison to previously reported ITT analysis. METHODS:Patients with at least 5-year follow-up data within the same treatment arm were included. Data collected every 3 months included use of nonoperative modalities, medications and employment status. Costs for surgeries and non-operative modalities were determined using Medicare Allowable rates. Medication costs were determined using the RedBook and indirect costs were calculated based on the reported employment status and income. Quality-Adjusted Life Years (QALY) was determined using the SF-6D. RESULTS: Of 226 patients, 195 patients (73 Non-op, 122 Op) met inclusion criteria. At 5 years, 29 (24%) patients in the Op group had a revision surgery of whom two had two revisions and one had three revisions. The cumulative cost for the Op group was $111,451 with a cumulative QALY gain of 2.3. The cumulative cost for the Non-Op group was $29,124 with a cumulative QALY gain of 0.4. This results in an ICER of $44,033 in favor of Op treatment. CONCLUSION: This as-treated cost-effectiveness analysis demonstrates that surgical treatment for adult lumbar scoliosis becomes favorable at year-three, 1 year earlier than suggested by a previous intent-to-treat analysis. LEVEL OF EVIDENCE: II.
Entities:
Keywords:
As-treated analysis; Cost-effectiveness; Lumbar scoliosis; Operative vs non-operative
Authors: Jamie Terran; Brian J McHugh; Charla R Fischer; Baron Lonner; Daniel Warren; Steven Glassman; Keith Bridwell; Frank Schwab; Virginie Lafage Journal: Ochsner J Date: 2014
Authors: Marinus de Kleuver; Sayf S A Faraj; Tsjitske M Haanstra; Anna K Wright; David W Polly; Miranda L van Hooff; Steven D Glassman Journal: Spine Deform Date: 2021-04-06