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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.

Author information

1
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: charla.fischer@gmail.com.
2
Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, 301 East 17th Street, New York, NY 10003, USA.
3
Department of Neurosurgery, Yale University, P.O. Box 208082, New Haven, CT 06520-8082, USA.
4
Department of Neurosurgery, Vancouver Island Health Authority, 1952 Bay Street, Victoria, British Columbia, Canada.
5
Department of Orthopaedics, Norton Leatherman Spine Center, 210 E Gray St, Louisville, KY.
6
Department of Orthopaedics, Washington University in St. Louis, 660 S. Euclid Ave, Campus Box 8233, St. Louis, MO 63110, USA.

Abstract

OBJECTIVE:

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

METHODS:

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.

RESULTS:

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.

CONCLUSIONS:

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.

KEYWORDS:

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

PMID:
27927342
DOI:
10.1016/j.jspd.2014.04.011

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