Factors Associated with the Maintenance of Cost-Effectiveness at 5 Years in Adult Spinal Deformity Corrective Surgery.
Document Type
Article
Publication Date
3-11-2024
Publication Title
Spine (Phila Pa 1976)
Keywords
washington; swedish; swedish neuro
Abstract
STUDY DESIGN: Retrospective cohort.
OBJECTIVE: To evaluate factors associated with the long-term durability of cost-effectiveness (CE) in ASD patients.
BACKGROUND: A substantial increase in costs associated with the surgical treatment for adult spinal deformity (ASD) has given precedence to scrutinize the value and utility it provides.
METHODS: We included 327 operative ASD patients with 5-year (5 Y) follow-up. Published methods were used to determine costs based on CMS.gov definitions and were based on the average DRG reimbursement rates. Utility was calculated using quality-adjusted life-years (QALY) utilizing the Oswestry Disability Index (ODI) converted to Short-Form Six-Dimension (SF-6D), with a 3% discount applied for its decline with life expectancy. The CE threshold of $150,000 was used for primary analysis.
RESULTS: Major and minor complication rates were 11% and 47% respectively, with 26% undergoing reoperation by 5 Y. The mean cost associated with surgery was $91,095±$47,003, with a utility gain of 0.091±0.086 at 1Y, QALY gained at 2 Y of 0.171±0.183, and at 5 Y of 0.42±0.43. The cost per QALY at 2 Y was $414,885, which decreased to $142,058 at 5 Y.With the threshold of $150,000 for CE, 19% met CE at 2 Y and 56% at 5 Y. In those in which revision was avoided, 87% met cumulative CE till life expectancy. Controlling analysis depicted higher baseline CCI and pelvic tilt (PT) to be the strongest predictors for not maintaining durable CE to 5 Y (CCI OR: 1.821 [1.159-2.862], P=0.009) (PT OR: 1.079 [1.007-1.155], P=0.030).
CONCLUSIONS: Most patients achieved cost-effectiveness after four years postoperatively, with 56% meeting at five years postoperatively. When revision was avoided, 87% of patients met cumulative cost-effectiveness till life expectancy. Mechanical complications were predictive of failure to achieve cost-effectiveness at 2 Y, while comorbidity burden and medical complications were at 5 Y.
Clinical Institute
Neurosciences (Brain & Spine)
Clinical Institute
Orthopedics & Sports Medicine
Department
Surgery
Department
Orthopedics
Department
Neurosciences
Recommended Citation
Passias, Peter G; Mir, Jamshaid M; Dave, Pooja; Smith, Justin S; Lafage, Renaud; Gum, Jeffrey; Line, Breton G; Diebo, Bassel; Daniels, Alan H; Hamilton, David Kojo; Buell, Thomas J; Scheer, Justin K; Eastlack, Robert K; Mullin, Jeffrey P; Mundis, Gregory M; Hosogane, Naobumi; Yagi, Mitsuru; Schoenfeld, Andrew J; Uribe, Juan S; Anand, Neel; Mummaneni, Praveen V; Chou, Dean; Klineberg, Eric O; Kebaish, Khaled M; Lewis, Stephen J; Gupta, Munish C; Kim, Han Jo; Hart, Robert A; Lenke, Lawrence G; Ames, Christopher P; Shaffrey, Christopher I; Schwab, Frank J; Lafage, Virginie; Hostin, Richard A; Bess, Shay; Burton, Douglas C; and Study Group, International Spine, "Factors Associated with the Maintenance of Cost-Effectiveness at 5 Years in Adult Spinal Deformity Corrective Surgery." (2024). Articles, Abstracts, and Reports. 8629.
https://digitalcommons.providence.org/publications/8629