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Ann Intern Med. 2008 Dec 16;149(12):845-53.

Surgical treatment of spinal stenosis with and without degenerative spondylolisthesis: cost-effectiveness after 2 years.

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  • 1Multidisciplinary Clinical Research Center in Musculoskeletal Diseases, Dartmouth Medical School, Hanover, New Hampshire 03756, USA.

Abstract

BACKGROUND:

The SPORT (Spine Patient Outcomes Research Trial) reported favorable surgery outcomes over 2 years among patients with stenosis with and without degenerative spondylolisthesis, but the economic value of these surgeries is uncertain.

OBJECTIVE:

To assess the short-term cost-effectiveness of spine surgery relative to nonoperative care for stenosis alone and for stenosis with spondylolisthesis.

DESIGN:

Prospective cohort study.

DATA SOURCES:

Resource utilization, productivity, and EuroQol EQ-5D score measured at 6 weeks and at 3, 6, 12, and 24 months after treatment among SPORT participants.

TARGET POPULATION:

Patients with image-confirmed spinal stenosis, with and without degenerative spondylolisthesis.

TIME HORIZON:

2 years.

PERSPECTIVE:

Societal.

INTERVENTION:

Nonoperative care or surgery (primarily decompressive laminectomy for stenosis and decompressive laminectomy with fusion for stenosis associated with degenerative spondylolisthesis).

OUTCOME MEASURES:

Cost per quality-adjusted life-year (QALY) gained.

RESULTS OF BASE-CASE ANALYSIS:

Among 634 patients with stenosis, 394 (62%) had surgery, most often decompressive laminectomy (320 of 394 [81%]). Stenosis surgeries improved health to a greater extent than nonoperative care (QALY gain, 0.17 [95% CI, 0.12 to 0.22]) at a cost of $77,600 (CI, $49,600 to $120,000) per QALY gained. Among 601 patients with degenerative spondylolisthesis, 368 (61%) had surgery, most including fusion (344 of 368 [93%]) and most with instrumentation (269 of 344 [78%]). Degenerative spondylolisthesis surgeries significantly improved health versus nonoperative care (QALY gain, 0.23 [CI, 0.19 to 0.27]), at a cost of $115,600 (CI, $90,800 to $144,900) per QALY gained. RESULT OF SENSITIVITY ANALYSIS: Surgery cost markedly affected the value of surgery.

LIMITATION:

The study used self-reported utilization data, 2-year time horizon, and as-treated analysis to address treatment nonadherence among randomly assigned participants.

CONCLUSION:

The economic value of spinal stenosis surgery at 2 years compares favorably with many health interventions. Degenerative spondylolisthesis surgery is not highly cost-effective over 2 years but could show value over a longer time horizon.

PMID:
19075203
PMCID:
PMC2658642
[PubMed - indexed for MEDLINE]
Free PMC Article
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