Factors predicting cost-effectiveness of adult spinal deformity surgery at 2 years

被引：22
作者：
Fischer C.R. [1 ,2 ]
Terran J. [2 ]
Lonner B. [2 ]
McHugh B. [3 ]
Warren D. [4 ]
Glassman S. [5 ]
Bridwell K. [6 ]
Schwab F. [2 ]
Lafage V. [2 ]
机构：
[1] Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, 10032, 622 West 168th Street
[2] Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY 10003
[3] Department of Neurosurgery, Yale University, New Haven, CT 06520-8082
[4] Department of Neurosurgery, Vancouver Island Health Authority, Victoria, BC
[5] Department of Orthopaedics, Norton Leatherman Spine Center, Louisville, KY
[6] Department of Orthopaedics, Washington University in St. Louis, St. Louis, MO 63110, 660 S. Euclid Ave
来源：
Spine Deformity | 2014年 / 2卷 / 5期
基金：
美国国家卫生研究院;
关键词：
Adult spinal deformity; Cost-effectiveness; QALY; Spinal fusion;
D O I：
10.1016/j.jspd.2014.04.011
中图分类号：
学科分类号：
摘要：
Objective To identify preoperative factors that lead to cost-effectiveness at 2 years' follow-up in the setting of surgical treatment for adult spinal deformity. Methods Retrospective analysis of a prospective, consecutive, multicenter database including 514 patients who underwent surgery for adult spinal deformity. The change in quality-adjusted life-years (QALY) was calculated from the 2-year change in Oswestry Disability Index (ODI). Medicare coding was used to determine the direct costs based on diagnosis-related group and Relative Value Unit reimbursement. Analysis was performed to determine which factors were associated with a cost/QALY less than $100,000, making the procedure cost-effective. Results The average QALY change for all patients in this study was 0.15 and the average cost/QALY was $243,761.97. A total of 56 patients (10.4%) had a cost/QALY of less than $100,000 at 2-year follow-up. Those patients were mostly female (89%), with a mean age of 60 years and the following diagnoses: 18 (32.1%) adult idiopathic scoliosis, 12 (35.7%) adult de novo scoliosis, 87 (14.3%) sagittal imbalance, and 10 (17.9%) other scoliosis. The Health-Related Quality of Life ODI and Scoliosis Research Society (SRS) instruments were all associated with cost-effectiveness except SRS-Mental. Factors associated with cost-effectiveness were age greater than 55 years, adult de novo scoliosis, prior surgery, higher preoperative sagittal vertical axis, lower maximum Cobb angles, 8 or fewer fusion levels, lower blood loss, worse global alignment classification, and global sagittal malalignment. Combined anterior-posterior surgeries were negatively associated with cost-effectiveness. Preoperative ODI scores between 60 and 70 and SRS Pain and Activity subscores more than 4 minimally clinically important difference points below the normative values had the highest percentage of cost-effective patients. Conclusions The QALY change is 0.15 and the cost/QALY of adult deformity surgery is $243,761.97 at 2 years. Patients with higher preoperative morbidity are more likely to be cost-effective with a cost/QALY less than $100,000. © 2014 Scoliosis Research Society.
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收藏
页码：415 / 422
页数：7
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