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Comparative Study
. 2024 Nov;12(6):1783-1791.
doi: 10.1007/s43390-024-00919-7. Epub 2024 Aug 2.

Thoracolumbar fusions for adult lumbar deformity show superior QALY gain and lower costs compared with upper thoracic fusions

Andrew H Kim  1 , Richard A Hostin  2 , Samrat Yeramaneni  2 , Jeffrey L Gum  3 , Pratibha Nayak  2 , Breton G Line  4 , Shay Bess  4 , Peter G Passias  5 , D Kojo Hamilton  6 , Munish C Gupta  7 , Justin S Smith  8 , Renaud Lafage  9 , Bassel G Diebo  10 , Virginie Lafage  11 , Eric O Klineberg  12 , Alan H Daniels  10 , Themistocles S Protopsaltis  6 , Frank J Schwab  11 , Christopher I Shaffrey  13 , Christopher P Ames  14 , Douglas C Burton  15 , Khaled M Kebaish  16 ; International Spine Study Group
Affiliations
Comparative Study

Thoracolumbar fusions for adult lumbar deformity show superior QALY gain and lower costs compared with upper thoracic fusions

Andrew H Kim et al. Spine Deform. 2024 Nov.

Abstract

Purpose: Adult spinal deformity (ASD) patients with sagittal plane deformity (N) or structural lumbar/thoraco-lumbar (TL) curves can be treated with fusions stopping at the TL junction or extending to the upper thoracic (UT) spine. This study evaluates the impact on cost/cumulative quality-adjusted life year (QALY) in patients treated with TL vs UT fusion.

Methods: ASD patients with > 4-level fusion and 2-year follow-up were included. Index and total episode-of-care costs were estimated using average itemized direct costs obtained from hospital records. Cumulative QALY gained were calculated from preoperative to 2-year postoperative change in Short Form Six-Dimension (SF-6D) scores. The TL and UT groups comprised patients with upper instrumented vertebrae (UIV) at T9-T12 and T2-T5, respectively.

Results: Of 566 patients with type N or L curves, mean age was 63.2 ± 12.1 years, 72% were female and 93% Caucasians. Patients in the TL group had better sagittal vertical axis (7.3 ± 6.9 vs. 9.2 ± 8.1 cm, p = 0.01), lower surgical invasiveness (- 30; p < 0.001), and shorter OR time (- 35 min; p = 0.01). Index and total costs were 20% lower in the TL than in the UT group (p < 0.001). Cost/QALY was 65% lower (492,174.6 vs. 963,391.4), and 2-year QALY gain was 40% higher, in the TL than UT group (0.15 vs. 0.10; p = 0.02). Multivariate model showed TL fusions had lower total cost (p = 0.001) and higher QALY gain (p = 0.03) than UT fusions.

Conclusion: In Schwab type N or L curves, TL fusions showed lower 2-year cost and improved QALY gain without increased reoperation rates or length of stay than UT fusions.

Level of evidence: III.

Keywords: Adult spinal deformity; Cost; Quality-adjusted life year; Thoracolumbar fusion; Upper thoracic fusion.

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References

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