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Spine Deform. 2014 Sep;2(5):415-422. doi: 10.1016/j.jspd.2014.04.011. Epub 2014 Aug 27.

Factors Predicting Cost-effectiveness of Adult Spinal Deformity Surgery at 2 Years.

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Department of Orthopaedic Surgery, Columbia University Medical Center, 622 West 168th Street, PH 11-1130, New York, NY, 10032, USA; Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, 301 East 17th Street, New York, NY 10003, USA. Electronic address:
Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, 301 East 17th Street, New York, NY 10003, USA.
Department of Neurosurgery, Yale University, P.O. Box 208082, New Haven, CT 06520-8082, USA.
Department of Neurosurgery, Vancouver Island Health Authority, 1952 Bay Street, Victoria, British Columbia, Canada.
Department of Orthopaedics, Norton Leatherman Spine Center, 210 E Gray St, Louisville, KY.
Department of Orthopaedics, Washington University in St. Louis, 660 S. Euclid Ave, Campus Box 8233, St. Louis, MO 63110, USA.



To identify preoperative factors that lead to cost-effectiveness at 2 years' follow-up in the setting of surgical treatment for adult spinal deformity.


Retrospective analysis of a prospective, consecutive, multicenter database including 514 patients who underwent surgery for adult spinal deformity. The change in quality-adjusted life-years (QALY) was calculated from the 2-year change in Oswestry Disability Index (ODI). Medicare coding was used to determine the direct costs based on diagnosis-related group and Relative Value Unit reimbursement. Analysis was performed to determine which factors were associated with a cost/QALY less than $100,000, making the procedure cost-effective.


The average QALY change for all patients in this study was 0.15 and the average cost/QALY was $243,761.97. A total of 56 patients (10.4%) had a cost/QALY of less than $100,000 at 2-year follow-up. Those patients were mostly female (89%), with a mean age of 60 years and the following diagnoses: 18 (32.1%) adult idiopathic scoliosis, 12 (35.7%) adult de novo scoliosis, 87 (14.3%) sagittal imbalance, and 10 (17.9%) other scoliosis. The Health-Related Quality of Life ODI and Scoliosis Research Society (SRS) instruments were all associated with cost-effectiveness except SRS-Mental. Factors associated with cost-effectiveness were age greater than 55 years, adult de novo scoliosis, prior surgery, higher preoperative sagittal vertical axis, lower maximum Cobb angles, 8 or fewer fusion levels, lower blood loss, worse global alignment classification, and global sagittal malalignment. Combined anterior-posterior surgeries were negatively associated with cost-effectiveness. Preoperative ODI scores between 60 and 70 and SRS Pain and Activity subscores more than 4 minimally clinically important difference points below the normative values had the highest percentage of cost-effective patients.


The QALY change is 0.15 and the cost/QALY of adult deformity surgery is $243,761.97 at 2 years. Patients with higher preoperative morbidity are more likely to be cost-effective with a cost/QALY less than $100,000.


Adult spinal deformity; Cost-effectiveness; QALY; Spinal fusion


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