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.

引用

页码：415 / 422

页数：7

共 37 条

[11]

Kamerlink J.R., Quirno M., Auerbach J.D., Et al., Hospital cost analysis of adolescent idiopathic scoliosis correction surgery in 125 consecutive cases, J Bone Joint Surg Am, 92, pp. 1097-1104, (2010)

[12]

Barnett D.B., Assessment of quality of life, Am J Cardiol, 67, (1991)

[13]

Grosse S.D., Teutsch S.M., Haddix A.C., Lessons from cost-effectiveness research for United States public health policy, Annu Rev Public Health, 28, pp. 365-391, (2007)

[14]

Schwab F., Ungar B., Blondel B., Et al., Scoliosis Research Society-Schwab adult spinal deformity classification: A validation study, Spine (Phila Pa 1976), 37, pp. 1077-1082, (2012)

[15]

Warren D., Hoelscher C.M., Terran J.S., Et al., Adult spinal deformity: A two-year cost-utility analysis and 10-year thought experiment, The American Academy of Orthopaedic Surgeons Annual Meeting, February 9, (2012)

[16]

Nichol M.B., Sengupta N., Globe D.R., Evaluating quality-adjusted life years: Estimation of the health utility index (HUI2) from the SF-36, Med Decis Making, 21, pp. 105-112, (2001)

[17]

Carreon L.Y., Glassman S.D., McDonough C.M., Et al., Predicting SF-6D utility scores from the Oswestry disability index and numeric rating scales for back and leg pain, Spine (Phila Pa 1976), 34, pp. 2085-2089, (2009)

[18]

Baldus C., Bridwell K., Harrast J., Et al., The Scoliosis Research Society Health-Related Quality of Life (SRS-30) age-gender normative data: An analysis of 1346 adult subjects unaffected by scoliosis, Spine (Phila Pa 1976), 36, pp. 1154-1162, (2011)

[19]

Berven S.D.V., Demir-Deviren S., Hu S., Bradford D., Minimal clinically important difference in adult spinal deformity: How much change is significant?, International Meeting for Advanced Surgical Techniques, IMAST 2005

[20]

Banff, Canada

← 1 2 3 4 →