Cost-effectiveness Improves for Operative Versus Non-operative Treatment of Adult Symptomatic Lumbar Scoliosis at Eight-year Follow-up

Leah Y. Carreon; Steven D. Glassman; Justin S. Smith; Michael P. Kelly; Elizabeth L. Yanik; Christine R. Baldus; Jon D. Lurie; Charles Edwards; Lawrence G. Lenke; Jacob M. Buchowski; Charles H. Crawford; Tyler Koski; Virginie Lafage; Munish Gupta; Han Jo Kim; Christopher P. Ames; Shay Bess; Frank J. Schwab; Christopher I. Shaffrey; Keith H. Bridwell

doi:10.1097/BRS.0000000000005186

Cost-effectiveness Improves for Operative Versus Non-operative Treatment of Adult Symptomatic Lumbar Scoliosis at Eight-year Follow-up

Leah Y. Carreon, Steven D. Glassman, Justin S. Smith, Michael P. Kelly, Elizabeth L. Yanik, Christine R. Baldus, Jon D. Lurie, Charles Edwards, Lawrence G. Lenke, Jacob M. Buchowski, Charles H. Crawford, Tyler Koski, Virginie Lafage, Munish Gupta, Han Jo Kim, Christopher P. Ames, Shay Bess, Frank J. Schwab, Christopher I. Shaffrey, Keith H. Bridwell

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Abstract

Study Design. Secondary data analysis of the NIH-sponsored study on adult symptomatic lumbar scoliosis (ASLS). Objectives. The purpose of this study is to perform a cost-effectiveness analysis comparing operative (Op) versus non-operative (Non-Op) care for ASLS 8 years after enrollment. Background. A prior cost-effectiveness analysis of the current cohort comparing Op to Non-Op care at 5 years after enrollment showed an incremental cost-effectiveness ratio (ICER) of $44,033 in the as-treated analysis and an ICER of $27,480 in the intent-to-treat analysis. Materials and Methods. Data were collected every 3 months for the first 2 years, and then every 6 months for the remainder of the study. Data included the use of Non-Op modalities, medications, and employment status. Costs for index and revision surgeries and Non-Op modalities were determined using Medicare Allowable rates. Medication costs were determined using the RedBook and indirect costs were calculated based on reported employment status and income. Quality-adjusted life years (QALYs) were determined using the Short Form-6 Dimensions. Results. There were 101 cases in the Op and 103 in the Non-Op group with complete 8-year data. Thirty-eight patients (37%) in the Non-Op group had surgery from 3 to 72 months after enrollment. An as-treated analysis including only cases who never had surgery (N = 65) or cases with complete 8-year postoperative data (N = 101) showed that Op treatment was favored with an ICER of $20,569 per QALY gained, which is within willingness-to-pay thresholds. An intent-to-treat analysis demonstrated greater QALY gains and lower costs in the Op group (ICER = -$13,911). However, intent-to-treat analysis is influenced by Non-Op patients who crossed over to Op treatment at variable times during follow-up. Conclusion. Op treatment was more cost-effective than Non-Op treatment for ASLS at 8-year follow-up. The ICER continued to improve as compared with the 5-year values ($20,569 vs. $44,033).

Original language	English
Pages (from-to)	586-592
Number of pages	7
Journal	Spine
Volume	50
Issue number	9
DOIs	https://doi.org/10.1097/BRS.0000000000005186
State	Published - May 1 2025

Keywords

adult lumbar scoliosis
adult scoliosis
cost-effectiveness
non-operative treatment
operative treatment

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10.1097/BRS.0000000000005186

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Carreon, L. Y., Glassman, S. D., Smith, J. S., Kelly, M. P., Yanik, E. L., Baldus, C. R., Lurie, J. D., Edwards, C., Lenke, L. G., Buchowski, J. M., Crawford, C. H., Koski, T., Lafage, V., Gupta, M., Kim, H. J., Ames, C. P., Bess, S., Schwab, F. J., Shaffrey, C. I., & Bridwell, K. H. (2025). Cost-effectiveness Improves for Operative Versus Non-operative Treatment of Adult Symptomatic Lumbar Scoliosis at Eight-year Follow-up. Spine, 50(9), 586-592. https://doi.org/10.1097/BRS.0000000000005186

@article{10e1126097f941c7b02f5938c01dc6cf,

title = "Cost-effectiveness Improves for Operative Versus Non-operative Treatment of Adult Symptomatic Lumbar Scoliosis at Eight-year Follow-up",

abstract = "Study Design. Secondary data analysis of the NIH-sponsored study on adult symptomatic lumbar scoliosis (ASLS). Objectives. The purpose of this study is to perform a cost-effectiveness analysis comparing operative (Op) versus non-operative (Non-Op) care for ASLS 8 years after enrollment. Background. A prior cost-effectiveness analysis of the current cohort comparing Op to Non-Op care at 5 years after enrollment showed an incremental cost-effectiveness ratio (ICER) of $44,033 in the as-treated analysis and an ICER of $27,480 in the intent-to-treat analysis. Materials and Methods. Data were collected every 3 months for the first 2 years, and then every 6 months for the remainder of the study. Data included the use of Non-Op modalities, medications, and employment status. Costs for index and revision surgeries and Non-Op modalities were determined using Medicare Allowable rates. Medication costs were determined using the RedBook and indirect costs were calculated based on reported employment status and income. Quality-adjusted life years (QALYs) were determined using the Short Form-6 Dimensions. Results. There were 101 cases in the Op and 103 in the Non-Op group with complete 8-year data. Thirty-eight patients (37%) in the Non-Op group had surgery from 3 to 72 months after enrollment. An as-treated analysis including only cases who never had surgery (N = 65) or cases with complete 8-year postoperative data (N = 101) showed that Op treatment was favored with an ICER of $20,569 per QALY gained, which is within willingness-to-pay thresholds. An intent-to-treat analysis demonstrated greater QALY gains and lower costs in the Op group (ICER = -$13,911). However, intent-to-treat analysis is influenced by Non-Op patients who crossed over to Op treatment at variable times during follow-up. Conclusion. Op treatment was more cost-effective than Non-Op treatment for ASLS at 8-year follow-up. The ICER continued to improve as compared with the 5-year values ($20,569 vs. $44,033).",

keywords = "adult lumbar scoliosis, adult scoliosis, cost-effectiveness, non-operative treatment, operative treatment",

author = "Carreon, {Leah Y.} and Glassman, {Steven D.} and Smith, {Justin S.} and Kelly, {Michael P.} and Yanik, {Elizabeth L.} and Baldus, {Christine R.} and Lurie, {Jon D.} and Charles Edwards and Lenke, {Lawrence G.} and Buchowski, {Jacob M.} and Crawford, {Charles H.} and Tyler Koski and Virginie Lafage and Munish Gupta and Kim, {Han Jo} and Ames, {Christopher P.} and Shay Bess and Schwab, {Frank J.} and Shaffrey, {Christopher I.} and Bridwell, {Keith H.}",

year = "2025",

month = may,

day = "1",

doi = "10.1097/BRS.0000000000005186",

language = "English",

volume = "50",

pages = "586--592",

journal = "Spine",

issn = "0362-2436",

number = "9",

}

Carreon, LY, Glassman, SD, Smith, JS, Kelly, MP, Yanik, EL, Baldus, CR, Lurie, JD, Edwards, C, Lenke, LG, Buchowski, JM, Crawford, CH, Koski, T, Lafage, V, Gupta, M, Kim, HJ, Ames, CP, Bess, S, Schwab, FJ, Shaffrey, CI & Bridwell, KH 2025, 'Cost-effectiveness Improves for Operative Versus Non-operative Treatment of Adult Symptomatic Lumbar Scoliosis at Eight-year Follow-up', Spine, vol. 50, no. 9, pp. 586-592. https://doi.org/10.1097/BRS.0000000000005186

TY - JOUR

T1 - Cost-effectiveness Improves for Operative Versus Non-operative Treatment of Adult Symptomatic Lumbar Scoliosis at Eight-year Follow-up

AU - Carreon, Leah Y.

AU - Glassman, Steven D.

AU - Smith, Justin S.

AU - Kelly, Michael P.

AU - Yanik, Elizabeth L.

AU - Baldus, Christine R.

AU - Lurie, Jon D.

AU - Edwards, Charles

AU - Lenke, Lawrence G.

AU - Buchowski, Jacob M.

AU - Crawford, Charles H.

AU - Koski, Tyler

AU - Lafage, Virginie

AU - Gupta, Munish

AU - Kim, Han Jo

AU - Ames, Christopher P.

AU - Bess, Shay

AU - Schwab, Frank J.

AU - Shaffrey, Christopher I.

AU - Bridwell, Keith H.

PY - 2025/5/1

Y1 - 2025/5/1

N2 - Study Design. Secondary data analysis of the NIH-sponsored study on adult symptomatic lumbar scoliosis (ASLS). Objectives. The purpose of this study is to perform a cost-effectiveness analysis comparing operative (Op) versus non-operative (Non-Op) care for ASLS 8 years after enrollment. Background. A prior cost-effectiveness analysis of the current cohort comparing Op to Non-Op care at 5 years after enrollment showed an incremental cost-effectiveness ratio (ICER) of $44,033 in the as-treated analysis and an ICER of $27,480 in the intent-to-treat analysis. Materials and Methods. Data were collected every 3 months for the first 2 years, and then every 6 months for the remainder of the study. Data included the use of Non-Op modalities, medications, and employment status. Costs for index and revision surgeries and Non-Op modalities were determined using Medicare Allowable rates. Medication costs were determined using the RedBook and indirect costs were calculated based on reported employment status and income. Quality-adjusted life years (QALYs) were determined using the Short Form-6 Dimensions. Results. There were 101 cases in the Op and 103 in the Non-Op group with complete 8-year data. Thirty-eight patients (37%) in the Non-Op group had surgery from 3 to 72 months after enrollment. An as-treated analysis including only cases who never had surgery (N = 65) or cases with complete 8-year postoperative data (N = 101) showed that Op treatment was favored with an ICER of $20,569 per QALY gained, which is within willingness-to-pay thresholds. An intent-to-treat analysis demonstrated greater QALY gains and lower costs in the Op group (ICER = -$13,911). However, intent-to-treat analysis is influenced by Non-Op patients who crossed over to Op treatment at variable times during follow-up. Conclusion. Op treatment was more cost-effective than Non-Op treatment for ASLS at 8-year follow-up. The ICER continued to improve as compared with the 5-year values ($20,569 vs. $44,033).

AB - Study Design. Secondary data analysis of the NIH-sponsored study on adult symptomatic lumbar scoliosis (ASLS). Objectives. The purpose of this study is to perform a cost-effectiveness analysis comparing operative (Op) versus non-operative (Non-Op) care for ASLS 8 years after enrollment. Background. A prior cost-effectiveness analysis of the current cohort comparing Op to Non-Op care at 5 years after enrollment showed an incremental cost-effectiveness ratio (ICER) of $44,033 in the as-treated analysis and an ICER of $27,480 in the intent-to-treat analysis. Materials and Methods. Data were collected every 3 months for the first 2 years, and then every 6 months for the remainder of the study. Data included the use of Non-Op modalities, medications, and employment status. Costs for index and revision surgeries and Non-Op modalities were determined using Medicare Allowable rates. Medication costs were determined using the RedBook and indirect costs were calculated based on reported employment status and income. Quality-adjusted life years (QALYs) were determined using the Short Form-6 Dimensions. Results. There were 101 cases in the Op and 103 in the Non-Op group with complete 8-year data. Thirty-eight patients (37%) in the Non-Op group had surgery from 3 to 72 months after enrollment. An as-treated analysis including only cases who never had surgery (N = 65) or cases with complete 8-year postoperative data (N = 101) showed that Op treatment was favored with an ICER of $20,569 per QALY gained, which is within willingness-to-pay thresholds. An intent-to-treat analysis demonstrated greater QALY gains and lower costs in the Op group (ICER = -$13,911). However, intent-to-treat analysis is influenced by Non-Op patients who crossed over to Op treatment at variable times during follow-up. Conclusion. Op treatment was more cost-effective than Non-Op treatment for ASLS at 8-year follow-up. The ICER continued to improve as compared with the 5-year values ($20,569 vs. $44,033).

KW - adult lumbar scoliosis

KW - adult scoliosis

KW - cost-effectiveness

KW - non-operative treatment

KW - operative treatment

UR - http://www.scopus.com/inward/record.url?scp=85206933973&partnerID=8YFLogxK

U2 - 10.1097/BRS.0000000000005186

DO - 10.1097/BRS.0000000000005186

M3 - Article

C2 - 39397347

AN - SCOPUS:85206933973

SN - 0362-2436

VL - 50

SP - 586

EP - 592

JO - Spine

JF - Spine

IS - 9

ER -

Cost-effectiveness Improves for Operative Versus Non-operative Treatment of Adult Symptomatic Lumbar Scoliosis at Eight-year Follow-up

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