Tags

Type your tag names separated by a space and hit enter

Cost-Effectiveness of Operative vs Nonoperative Treatment of Adult Symptomatic Lumbar Scoliosis an Intent-to-Treat Analysis at Five Year Follow-up.

Abstract

STUDY DESIGN

Secondary analysis using data from the NIH sponsored study on Adult Symptomatic Lumbar Scoliosis (ASLS) that included randomized and observational arms.

OBJECTIVES

To perform an intent-to-treat cost-effectiveness study comparing operative versus non-operative care for ASLS.

SUMMARY OF BACKGROUND DATA

The appropriate treatment approach for ASLS continues to be ill-defined. Nonoperative care has not been shown to improve outcomes. Surgical treatment has been shown to improve outcomes, but is costly with high revision rates.

METHODS

Patients with at least five-year follow-up data were included. Data collected every three months included use of nonoperative modalities, medications and employment status. Costs for index and revision surgeries and non-operative modalities were determined using Medicare Allowable rates. Medication costs were determined using the RedBook and indirect costs were calculated based on reported employment status and income. Quality Adjusted Life Years (QALY) was determined using the SF6D.

RESULTS

There were 81 of 95 cases in the Operative (Op) and 81 of 95 in the Non-operative (Non-Op) group with complete five-year follow-up data. Not all patients were eligible for fiveyear follow-up at the time of the analysis. All patients in the Op and 24 (30%) in the NonOp group had surgery by five years. At five years, the cumulative cost for Op was $96,000 with a QALY gain of 2.44 and for Non-Op the cumulative cost was $49,546 with a QALY gain of 0.75 with an Incremental Cost-effectiveness Ratio (ICER) of $27,480 per QALY gain.

CONCLUSION

In an intent-to-treat analysis, neither treatment was dominant, as the greater gains in QALY in the surgery group come at a greater cost. The ICER for operative compared to non-operative treatment was above the threshold generally considered cost-effective in the first three years of the study but improved over time and was highly costeffective at four and five years.

LEVEL OF EVIDENCE

2.

Links

  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY, 40202.

    ,

    Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY, 40202. University of Louisville School of Medicine Department of Orthopaedic Surgery, 550 S. Jackson St., 1st Floor ACB Louisville, KY 40202.

    ,

    Department of Medicine, Geisel School of Medicine at Dartmouth, One Medical Center Dr., Lebanon, NH 03756.

    ,

    Department of Orthopaedic Surgery Spine Division, Duke University School of Medicine, DUMC Box 3000, Durham, North Carolina 27710.

    ,

    Department of Orthopaedic Surgery, Washington University School of Medicine, 660 S. Euclid Ave, Campus Box 8233, St. Louis, MO 63110.

    ,

    Department of Orthopaedic Surgery, Washington University School of Medicine, 660 S. Euclid Ave, Campus Box 8233, St. Louis, MO 63110.

    ,

    Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY, 40202.

    ,

    Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY, 40202. University of Louisville School of Medicine Department of Orthopaedic Surgery, 550 S. Jackson St., 1st Floor ACB Louisville, KY 40202.

    ,

    Department of Orthopaedic Surgery, Washington University School of Medicine, 660 S. Euclid Ave, Campus Box 8233, St. Louis, MO 63110.

    Department of Orthopaedic Surgery, Washington University School of Medicine, 660 S. Euclid Ave, Campus Box 8233, St. Louis, MO 63110.

    Source

    Spine : 2019 Jun 12 pg

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    31205182

    Citation

    Carreon, Leah Y., et al. "Cost-Effectiveness of Operative Vs Nonoperative Treatment of Adult Symptomatic Lumbar Scoliosis an Intent-to-Treat Analysis at Five Year Follow-up." Spine, 2019.
    Carreon LY, Glassman SD, Lurie J, et al. Cost-Effectiveness of Operative vs Nonoperative Treatment of Adult Symptomatic Lumbar Scoliosis an Intent-to-Treat Analysis at Five Year Follow-up. Spine. 2019.
    Carreon, L. Y., Glassman, S. D., Lurie, J., Shaffrey, C. I., Kelly, M. P., Baldus, C. R., ... Bridwell, K. H. (2019). Cost-Effectiveness of Operative vs Nonoperative Treatment of Adult Symptomatic Lumbar Scoliosis an Intent-to-Treat Analysis at Five Year Follow-up. Spine, doi:10.1097/BRS.0000000000003118.
    Carreon LY, et al. Cost-Effectiveness of Operative Vs Nonoperative Treatment of Adult Symptomatic Lumbar Scoliosis an Intent-to-Treat Analysis at Five Year Follow-up. Spine. 2019 Jun 12; PubMed PMID: 31205182.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Cost-Effectiveness of Operative vs Nonoperative Treatment of Adult Symptomatic Lumbar Scoliosis an Intent-to-Treat Analysis at Five Year Follow-up. AU - Carreon,Leah Y, AU - Glassman,Steven D, AU - Lurie,Jon, AU - Shaffrey,Christopher I, AU - Kelly,Michael P, AU - Baldus,Christine R, AU - Bratcher,Kelly R, AU - Crawford,Charles H, AU - Yanik,Elizabeth L, AU - Bridwell,Keith H, Y1 - 2019/06/12/ PY - 2019/6/18/entrez JF - Spine JO - Spine N2 - STUDY DESIGN: Secondary analysis using data from the NIH sponsored study on Adult Symptomatic Lumbar Scoliosis (ASLS) that included randomized and observational arms. OBJECTIVES: To perform an intent-to-treat cost-effectiveness study comparing operative versus non-operative care for ASLS. SUMMARY OF BACKGROUND DATA: The appropriate treatment approach for ASLS continues to be ill-defined. Nonoperative care has not been shown to improve outcomes. Surgical treatment has been shown to improve outcomes, but is costly with high revision rates. METHODS: Patients with at least five-year follow-up data were included. Data collected every three months included use of nonoperative modalities, medications and employment status. Costs for index and revision surgeries and non-operative modalities were determined using Medicare Allowable rates. Medication costs were determined using the RedBook and indirect costs were calculated based on reported employment status and income. Quality Adjusted Life Years (QALY) was determined using the SF6D. RESULTS: There were 81 of 95 cases in the Operative (Op) and 81 of 95 in the Non-operative (Non-Op) group with complete five-year follow-up data. Not all patients were eligible for fiveyear follow-up at the time of the analysis. All patients in the Op and 24 (30%) in the NonOp group had surgery by five years. At five years, the cumulative cost for Op was $96,000 with a QALY gain of 2.44 and for Non-Op the cumulative cost was $49,546 with a QALY gain of 0.75 with an Incremental Cost-effectiveness Ratio (ICER) of $27,480 per QALY gain. CONCLUSION: In an intent-to-treat analysis, neither treatment was dominant, as the greater gains in QALY in the surgery group come at a greater cost. The ICER for operative compared to non-operative treatment was above the threshold generally considered cost-effective in the first three years of the study but improved over time and was highly costeffective at four and five years. LEVEL OF EVIDENCE: 2. SN - 1528-1159 UR - https://www.unboundmedicine.com/medline/citation/31205182/Cost-Effectiveness_of_Operative_vs_Nonoperative_Treatment_of_Adult_Symptomatic_Lumbar_Scoliosis_an_Intent-to-Treat_Analysis_at_Five_Year_Follow-up L2 - http://dx.doi.org/10.1097/BRS.0000000000003118 DB - PRIME DP - Unbound Medicine ER -