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Comparative Study
. 2020 Dec;8(6):1333-1339.
doi: 10.1007/s43390-020-00154-w. Epub 2020 Jul 6.

Cost-effectiveness of adult lumbar scoliosis surgery: an as-treated analysis from the adult symptomatic scoliosis surgery trial with 5-year follow-up

Steven D Glassman  1   2 , Leah Y Carreon  3 , Christopher I Shaffrey  4 , Michael P Kelly  5 , Charles H Crawford 3rd  1   2 , Elizabeth L Yanik  5 , Jon D Lurie  6 , R Shay Bess  7 , Christine R Baldus  4 , Keith H Bridwell  4
Affiliations
Comparative Study

Cost-effectiveness of adult lumbar scoliosis surgery: an as-treated analysis from the adult symptomatic scoliosis surgery trial with 5-year follow-up

Steven D Glassman et al. Spine Deform. 2020 Dec.

Abstract

Study design: Longitudinal comparative cohort.

Objective: The purpose of this study is to report on the cost-effectiveness of surgical versus non-surgical treatment for Adult Symptomatic Lumbar Scoliosis (ASLS) using the as-treated data and provide a comparison to previously reported intent-to-treat (ITT) analysis. Adult spinal deformity is a relatively prevalent condition for which surgical treatment has become increasingly common but concerns surrounding complications, revision rates and cost-effectiveness remain unresolved. Of these issues, cost-effectiveness is perhaps the most difficult to quantify as the requisite data is difficult to obtain. The purpose of this study is to report on the cost-effectiveness of surgical versus non-surgical treatment for ASLS using the as-treated data and provide a comparison to previously reported ITT analysis.

Methods: Patients with at least 5-year follow-up data within the same treatment arm were included. Data collected every 3 months included use of nonoperative modalities, medications and employment status. Costs for 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 the reported employment status and income. Quality-Adjusted Life Years (QALY) was determined using the SF-6D.

Results: Of 226 patients, 195 patients (73 Non-op, 122 Op) met inclusion criteria. At 5 years, 29 (24%) patients in the Op group had a revision surgery of whom two had two revisions and one had three revisions. The cumulative cost for the Op group was $111,451 with a cumulative QALY gain of 2.3. The cumulative cost for the Non-Op group was $29,124 with a cumulative QALY gain of 0.4. This results in an ICER of $44,033 in favor of Op treatment.

Conclusion: This as-treated cost-effectiveness analysis demonstrates that surgical treatment for adult lumbar scoliosis becomes favorable at year-three, 1 year earlier than suggested by a previous intent-to-treat analysis.

Level of evidence: II.

Keywords: As-treated analysis; Cost-effectiveness; Lumbar scoliosis; Operative vs non-operative.

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Figures

Figure 1.
Figure 1.
Flowchart of subjects in the first year of follow-up. Of the 122 subjects in the Op group, 9 (7%) subjects had a revision surgery within the first year after their index surgery. The cumulative cost for the Op group was $74,050 with a QALY gain of 0.1. The cumulative cost in the first year for the Non-Op group was $6,353 with a QALY gain of 0.0. The ICER was $704,897 per QALY gained.
Figure 2.
Figure 2.
Flowchart of subjects in the second year of follow-up. Sixteen patients (13%) patients in the Op group had a revision surgery. The cumulative cost over two years for the Op group was $79,325 with a QALY gain of 0.4. The cumulative cost over two years for the Non-Op group was $15,101 with a QALY gain of 0.1. The ICER was $196,721 per QALY gained
Figure 3.
Figure 3.
Flowchart of subjects in the third year of follow-up. 22 patients (18%) in the Op group had a revision surgery with one patient having had two revisions, with a cumulative cost of $85,299 and QALY gain of 0.9. In the Non-Op group, the cumulative cost was $19,195 and QALY gain of 0.2. This results in an ICER of $93,405 per QALY gained
Figure 4.
Figure 4.
Flowchart of subjects in the fourth year of follow-up, 25 (22%) patients had one revision and two patients had two revisions, with a cumulative cost of $95,572 and QALY gain of 1.5. The cumulative cost for the NonOp group was $22,953 with a QALY gain of 0.3. This results in an ICER of $57,309 per QALY gained.
Figure 5.
Figure 5.
Flowchart of subjects in the fifth year of follow-up, 29 (24%) of patients in the Op group had a revision surgery of whom two had two revisions and one had three revisions. The cumulative cost for the Op group at five years was $111,451 with a cumulative QALY gain of 2.3. The cumulative cost for the Non-Op group was $29,124 with a cumulative QALY gain of 0.4. This results in an ICER of $44,033 per QALY gained.
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References

    1. Schwab F, Dubey A, Gamez L, El Fegoun AB, Hwang K, Pagala M, Farcy JP. Adult scoliosis: prevalence, SF-36, and nutritional parameters in an elderly volunteer population. Spine (Phila Pa 1976). 2005. May 1;30(9):1082–5. - PubMed
    1. Bridwell KH, Glassman S, Horton W, Shaffrey C, Schwab F, Zebala LP, Lenke LG, Hilton JF, Shainline M, Baldus C, Wootten D. Does treatment (nonoperative and operative) improve the two-year quality of life in patients with adult symptomatic lumbar scoliosis: a prospective multicenter evidence-based medicine study. Spine (Phila Pa 1976). 2009. September 15;34(20):2171–8. - PubMed
    1. Kelly MP, Lurie JD, Yanik EL, Shaffrey CI, Baldus CR, Boachie-Adjei O, Buchowski JM, Carreon LY, Crawford CH 3rd, Edwards C 2nd, Errico TJ, Glassman SD, Gupta MC, Lenke LG, Lewis SJ, Kim HJ, Koski T, Parent S, Schwab FJ, Smith JS, Zebala LP, Bridwell KH. Operative Versus Nonoperative Treatment for Adult Symptomatic Lumbar Scoliosis. J Bone Joint Surg Am. 2019. February 20;101(4):338–352. - PMC - PubMed
    1. Glassman SD, Dimar JR 2nd, Carreon LY. Revision Rate After Adult Deformity Surgery. Spine Deform. 2015. March;3(2):199–203 - PubMed
    1. McCarthy I, O’Brien M, Ames C, Robinson C, Errico T, Polly DW Jr, Hostin R; International Spine Study Group. Incremental cost-effectiveness of adult spinal deformity surgery: observed quality-adjusted life years with surgery compared with predicted quality-adjusted life years without surgery. Neurosurg Focus. 2014. May;36(5):E3. - PubMed

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