TY - JOUR
T1 - Factors predicting cost-effectiveness of adult spinal deformity surgery at 2 years
AU - Fischer, Charla R.
AU - Terran, Jamie
AU - Lonner, Baron
AU - McHugh, Brian
AU - Warren, Dan
AU - Glassman, Steven
AU - Bridwell, Keith
AU - Schwab, Frank
AU - Lafage, Virginie
N1 - Funding Information:
Author disclosures: CRF (none); JT (none); BL (grants from Setting Scoliosis Straight Foundation , John and Marcella Fox Fund , OREF, Depuy Spine ; personal fees from Depuy Spine, Paradigm Spine, Spine Search, K2M; grants from AO Spine, outside the submitted work); BM (none); DW (none); SG (other from Norton Healthcare , Medtronic Sofamor Danek , Nuvasive , SRS , outside the submitted work; patent US Application No. 12/013,838 with royalties paid); KB (none); FS (grants from MSD , during the conduct of the study; personal fees from MSD, K2M, Nemaris, Inc, MSD, DePuy, K2M, MSD; grants from DePuy , MSD, AO, outside the submitted work; patent MSD with royalties paid, a patent K2M pending, patent Nemaris, Inc, pending.); VL (grants from MSD, during the conduct of the study; personal fees from Nemaris, Inc, MSD, DePuy, K2M; grants from DePuy, ISSG, SRS, NIH, outside the submitted work).
PY - 2014/9
Y1 - 2014/9
N2 - 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.
AB - 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.
KW - Adult spinal deformity
KW - Cost-effectiveness
KW - QALY
KW - Spinal fusion
UR - http://www.scopus.com/inward/record.url?scp=84906832691&partnerID=8YFLogxK
U2 - 10.1016/j.jspd.2014.04.011
DO - 10.1016/j.jspd.2014.04.011
M3 - Article
AN - SCOPUS:84906832691
SN - 2212-134X
VL - 2
SP - 415
EP - 422
JO - Spine Deformity
JF - Spine Deformity
IS - 5
ER -