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Surgery for spine disorders remains cost-effective over 4 years
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Data from the SPORT study indicates that surgical treatment for degenerative spondylolisthesis, spinal stenosis and intervertebral disc herniation is cost-effective during a 4-year follow-up when compared with nonoperative care.
The research, conducted by Anna N.A. Tosteson, ScD, and colleagues, appeared in Spine.
“In comparison to nonoperative care, the surgeries studied for herniated disc and spinal stenosis (with or without degenerative spondylolisthesis) are cost-effective. The estimated costs per [quality-adjusted life years] QALY gained compared favorably with other widely accepted health care interventions,” Tosteson, from the Dartmouth Institute for Health Policy and Clinical Practice at the Dartmouth Medical School in Lebanon, N.H., told Orthopedics Today. “However, it is important to emphasize that we studied very specific indications for surgery and that the SPORT study was not designed to compare different types of surgery.”
The study included 601 patients with degenerative spondylolisthesis, 634 patients with spinal stenosis and 1,192 patients with intervertebral disc herniation. Researchers studied both patients who were randomly assigned to receive either surgery or nonoperative treatment and those who chose their treatment. Roughly two-thirds of the patients had surgery during the 4-year follow-up. Resource use, productivity and EuroQol EQ-5D health outcome measures were measured at 6 weeks, 3 months, 6 months, 1 year, 2 years, 3 years and 4 years, according to the study abstract. All estimates of cost were adjusted to 2004 U.S. dollars.
Surgery costs were compared at 2-year and 4-year follow-ups. The cost-effectiveness of surgery for degenerative spondylolisthesis, which also had the highest initial costs, improved the most between 2 years and 4 years. It decreased from $115,600 at 2 years to $64,300 per QALY gained at 4 years. Surgery for spinal stenosis was the second most improved, with $77,600 at 2 years decreasing to $59,400 per QALY gained at 4 years. Surgery for intervertebral disc herniation was the most cost-effective, but saw the smallest improvement in value between 2 years and 4 years, decreasing from $34,355 to $20,600 per QALY gained.
“These data provide a basis for promoting fully informed choice[s] for patients with disc herniation or spine stenosis with or without degenerative spondylolisthesis who face a difficult decision of whether or not to undergo spine surgery,” Tosteson stated in a press release. – by Jeff Craven
Reference:
- Tosteson ANA, Tosteson TD, Lurie JD, et al. Comparative effectiveness evidence from the Spine Patient Outcomes Research Trial: Surgical versus nonoperative care for spinal stenosis, degenerative spondylolisthesis and intervertebral disc herniation. Spine. 2011; 36:24:2061-2068.
- Anna N.A. Tosteson, ScD, can be reached at Multidisciplinary Clinical Research Center in Musculoskeletal Diseases, Comparative Effectiveness Research Program, The Dartmouth Institute for Health Policy and Clinical Practice Dartmouth Medical School, 1 Medical Center Drive HB7505, Lebanon, NH 03756; 603-653-3568; email: anna.n.a.tosteson@dartmouth.edu.
- Disclosure: Tosteson has no relevant financial disclosures.
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Readers should take particular note of this article by Tosteson and colleagues for three specific reasons. First, the paper is an example of the type of socioeconomic study that will become increasingly important as the government and third-party payers embrace economic analysis methodologies to make reimbursement decisions.
Second, as an educational endeavor, readers can gain an understanding of the ratio used to express cost-effectiveness in terms of the cost in dollars per quality adjusted life year (QALY) gained. The numerator (cost) in the ratio is fairly straightforward. The denominator (QALY) of the ratio is harder to grasp. It consists of a utility score (0 – 1, with 0 being death and 1 a state of perfect health calculated from instruments such as the EQ-5D). The utility score is then multiplied by the years where the improvement in health status is maintained.
Finally, the article illustrates the importance of timing to apply the cost-effectiveness principle in reimbursement decisions. Sustained improvement in health status equates to a lower cost per QALY over time. A different reimbursement decision might be made looking at the cost per QALY at 1 year vs. 2 years.
— David A. Wong, MD
Orthopedics
Today Editorial Board member
Denver Spine Center
Denver
Disclosure: Wong has no relevant financial disclosures.