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Revision lumbar surgery in elderly patients with symptomatic pseudarthrosis, adjacent-segment disease, or same-level recurrent stenosis. Part 2. A cost-effectiveness analysis: clinical article.
J Neurosurg Spine. 2013 Feb; 18(2):147-53.JN

Abstract

OBJECT

Despite advances in technology and understanding in spinal physiology, reoperation for symptomatic adjacent-segment disease (ASD), same-level recurrent stenosis, and pseudarthrosis in elderly patients continues to occur. While revision lumbar surgery is effective, attention has turned to questions on the utility and value of the revision decompression and fusion procedure. To date, an analysis of the cost and health state gain associated with revision lumbar surgery in elderly patients with symptomatic pseudarthrosis, ASD, or same-level recurrent lumbar stenosis has yet to be performed. The aim of this study was to assess the long-term outcomes and cost-effectiveness of revision surgery in elderly patients with recurrent or persistent back and leg pain.

METHODS

After reviewing their institutional database, the authors found 69 patients 65 years of age and older who had undergone revision decompression and instrumented fusion for back and leg pain associated with pseudarthrosis (17 patients), same-level recurrent stenosis (24 patients), or ASD (28 patients) and included them in this study. Total 2-year back-related medical resource utilization and health state values (quality-adjusted life years [QALYs], calculated from the EQ-5D, the EuroQol-5D health survey, with US valuation) were assessed. Two-year resource use was multiplied by unit costs based on Medicare national allowable payment amounts. The mean total 2-year cost per QALY gained after revision surgery was assessed.

RESULTS

The mean (± standard deviation) time between the index surgery and revision surgery was 3.51 ± 3.63 years. A mean cumulative 2-year gain of 0.35 QALY was observed after revision surgery. The mean total 2-year cost of revision surgery was $28,256 ± $3000 (ASD: $28,829 ± $3812, pseudarthrosis: $28,069 ± $2508, same-level recurrent stenosis: $27,871 ± $2375). Revision decompression and extension of fusion was associated with a mean 2-year cost of $80,594 per QALY gained.

CONCLUSIONS

Revision decompression and fusion provided a significant gain in health state utility for elderly patients with symptomatic pseudarthrosis, same-level recurrent stenosis, or ASD, with a mean 2-year cost of $80,594 per QALY gained. When indicated, revision surgery for symptomatic ASD, same-level recurrent stenosis, and pseudarthrosis is a valuable treatment option for elderly patients experiencing persistent back and leg pain. Findings in this study provided a value measure of surgery that can be compared with future cost-per-QALY-gained studies of medical management or alternative surgical approaches.

Authors+Show Affiliations

Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA. owoicho.adogwa@gmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23231358

Citation

Adogwa, Owoicho, et al. "Revision Lumbar Surgery in Elderly Patients With Symptomatic Pseudarthrosis, Adjacent-segment Disease, or Same-level Recurrent Stenosis. Part 2. a Cost-effectiveness Analysis: Clinical Article." Journal of Neurosurgery. Spine, vol. 18, no. 2, 2013, pp. 147-53.
Adogwa O, Owens R, Karikari I, et al. Revision lumbar surgery in elderly patients with symptomatic pseudarthrosis, adjacent-segment disease, or same-level recurrent stenosis. Part 2. A cost-effectiveness analysis: clinical article. J Neurosurg Spine. 2013;18(2):147-53.
Adogwa, O., Owens, R., Karikari, I., Agarwal, V., Gottfried, O. N., Bagley, C. A., Isaacs, R. E., & Cheng, J. S. (2013). Revision lumbar surgery in elderly patients with symptomatic pseudarthrosis, adjacent-segment disease, or same-level recurrent stenosis. Part 2. A cost-effectiveness analysis: clinical article. Journal of Neurosurgery. Spine, 18(2), 147-53. https://doi.org/10.3171/2012.11.SPINE12226
Adogwa O, et al. Revision Lumbar Surgery in Elderly Patients With Symptomatic Pseudarthrosis, Adjacent-segment Disease, or Same-level Recurrent Stenosis. Part 2. a Cost-effectiveness Analysis: Clinical Article. J Neurosurg Spine. 2013;18(2):147-53. PubMed PMID: 23231358.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Revision lumbar surgery in elderly patients with symptomatic pseudarthrosis, adjacent-segment disease, or same-level recurrent stenosis. Part 2. A cost-effectiveness analysis: clinical article. AU - Adogwa,Owoicho, AU - Owens,Ryan, AU - Karikari,Isaac, AU - Agarwal,Vijay, AU - Gottfried,Oren N, AU - Bagley,Carlos A, AU - Isaacs,Robert E, AU - Cheng,Joseph S, Y1 - 2012/12/11/ PY - 2012/12/13/entrez PY - 2012/12/13/pubmed PY - 2013/5/17/medline SP - 147 EP - 53 JF - Journal of neurosurgery. Spine JO - J Neurosurg Spine VL - 18 IS - 2 N2 - OBJECT: Despite advances in technology and understanding in spinal physiology, reoperation for symptomatic adjacent-segment disease (ASD), same-level recurrent stenosis, and pseudarthrosis in elderly patients continues to occur. While revision lumbar surgery is effective, attention has turned to questions on the utility and value of the revision decompression and fusion procedure. To date, an analysis of the cost and health state gain associated with revision lumbar surgery in elderly patients with symptomatic pseudarthrosis, ASD, or same-level recurrent lumbar stenosis has yet to be performed. The aim of this study was to assess the long-term outcomes and cost-effectiveness of revision surgery in elderly patients with recurrent or persistent back and leg pain. METHODS: After reviewing their institutional database, the authors found 69 patients 65 years of age and older who had undergone revision decompression and instrumented fusion for back and leg pain associated with pseudarthrosis (17 patients), same-level recurrent stenosis (24 patients), or ASD (28 patients) and included them in this study. Total 2-year back-related medical resource utilization and health state values (quality-adjusted life years [QALYs], calculated from the EQ-5D, the EuroQol-5D health survey, with US valuation) were assessed. Two-year resource use was multiplied by unit costs based on Medicare national allowable payment amounts. The mean total 2-year cost per QALY gained after revision surgery was assessed. RESULTS: The mean (± standard deviation) time between the index surgery and revision surgery was 3.51 ± 3.63 years. A mean cumulative 2-year gain of 0.35 QALY was observed after revision surgery. The mean total 2-year cost of revision surgery was $28,256 ± $3000 (ASD: $28,829 ± $3812, pseudarthrosis: $28,069 ± $2508, same-level recurrent stenosis: $27,871 ± $2375). Revision decompression and extension of fusion was associated with a mean 2-year cost of $80,594 per QALY gained. CONCLUSIONS: Revision decompression and fusion provided a significant gain in health state utility for elderly patients with symptomatic pseudarthrosis, same-level recurrent stenosis, or ASD, with a mean 2-year cost of $80,594 per QALY gained. When indicated, revision surgery for symptomatic ASD, same-level recurrent stenosis, and pseudarthrosis is a valuable treatment option for elderly patients experiencing persistent back and leg pain. Findings in this study provided a value measure of surgery that can be compared with future cost-per-QALY-gained studies of medical management or alternative surgical approaches. SN - 1547-5646 UR - https://www.unboundmedicine.com/medline/citation/23231358/Revision_lumbar_surgery_in_elderly_patients_with_symptomatic_pseudarthrosis_adjacent_segment_disease_or_same_level_recurrent_stenosis__Part_2__A_cost_effectiveness_analysis:_clinical_article_ L2 - https://thejns.org/doi/10.3171/2012.11.SPINE12226 DB - PRIME DP - Unbound Medicine ER -