Surgical Management of the Elderly With Traumatic Cervical Spinal Cord Injury: A Cost-Utility Analysis

Abstract

Background: Aging of the population has modified the epidemiology of traumatic spinal cord injury (SCI) as evidenced by the establishment of a bimodal distribution of injuries with increased frequency of fall-related injuries among the elderly.

Objective: To assess the economic impact of older age (65 years of age and older), using a cost-utility analysis, in the context of acute surgical management and rehabilitation of traumatic cervical SCI, given the paucity of economic studies involving elderly individuals with SCI.

Methods: The cost-utility analysis was performed from the perspective of a public health care insurer. A time horizon of 6 months from SCI onset was used. Costs were estimated in 2014 US dollars. Utilities were generated from the Surgical Timing in Acute Spinal Cord Injury study.

Results: The baseline analysis indicated that surgical and rehabilitative management of acute cervical SCI in the elderly (n = 17) is costlier, but similarly effective, than that in younger adults (n = 47). When considering acute spinal surgical management and rehabilitation of younger adults with SCI as the baseline, the incremental cost-effectiveness ratio analysis revealed an additional cost of $5 655 557 per quality-adjusted life-year gained when managing elderly patients with traumatic cervical SCI. The probabilistic analysis confirmed that spinal surgery in the elderly is costlier, but similarly effective, in younger adults after SCI, even though there is no definitive dominance.

Conclusion: This economic analysis indicates that surgical management and rehabilitation of acute traumatic cervical SCI in the elderly are costlier but similarly effective compared with younger adults with similar impairment.

Abbreviations: AIS, ASIA (American Spinal Injury Association) Impairment Scale.