TY - JOUR
T1 - Cost-effectiveness of adult lumbar scoliosis surgery
T2 - an as-treated analysis from the adult symptomatic scoliosis surgery trial with 5-year follow-up
AU - Glassman, Steven D.
AU - Carreon, Leah Y.
AU - Shaffrey, Christopher I.
AU - Kelly, Michael P.
AU - Crawford, Charles H.
AU - Yanik, Elizabeth L.
AU - Lurie, Jon D.
AU - Bess, R. Shay
AU - Baldus, Christine R.
AU - Bridwell, Keith H.
N1 - Funding Information:
Funding was received from the National Institutes of Health, the Scoliosis Research Society and International Spine Study Group Foundation.
Funding Information:
This is a secondary analysis of prospective data collected from subjects enrolled in nine centers in North America. The primary study evaluated operative and nonoperative treatments in patients with ASLS and included randomized and observational arms []. The current study included patients between 40 and 80 years old with lumbar scoliosis with coronal Cobb ≥ 30°, and either an Oswestry Disability Index (ODI) [] score of 20 or greater, or a Scoliosis Research Society-22 (SRS-22) [] Pain, Function or Appearance score less than 4.0, and no prior fusion surgery. Exclusion criteria were the presence of medical comorbidities that precluded surgery, high-grade (≥ 3) spondylolisthesis, prior thoracic or lumbar fusion, prior multilevel (≥ 3) thoracolumbar decompression, severe osteoporosis (femoral neck t-score ≥ − 3.0), neuromuscular scoliosis and presence of congenital lumbar spine anomalies. Subjects were enrolled from 2010 to 2014. Funding was provided by the National Institutes of Health through an RO1 grant: A Multi-Center Prospective Study of Quality of Life in Adult Scoliosis (R01AR055176-01A2). Institutional review board approval was obtained at each participating center prior to subject enrollment. Institutional review board approval was also obtained for this secondary analysis.
Funding Information:
The purpose of this study is to report on the cost-effectiveness of surgical versus non-surgical treatment for adult symptomatic lumbar scoliosis. The assessment is based upon an ICER evaluation from the NIH supported Adult Symptomatic Lumbar Scoliosis (ASLS) trial. This study analyzes the as-treated data and also provides a comparison to previously reported intent-to-treat (ITT) analysis [].
Publisher Copyright:
© 2020, Scoliosis Research Society.
PY - 2020/12
Y1 - 2020/12
N2 - Study design: Longitudinal comparative cohort. Objective: The purpose of this study is to report on the cost-effectiveness of surgical versus non-surgical treatment for Adult Symptomatic Lumbar Scoliosis (ASLS) using the as-treated data and provide a comparison to previously reported intent-to-treat (ITT) analysis. Summary of background data: Adult spinal deformity is a relatively prevalent condition for which surgical treatment has become increasingly common but concerns surrounding complications, revision rates and cost-effectiveness remain unresolved. Of these issues, cost-effectiveness is perhaps the most difficult to quantify as the requisite data is difficult to obtain. The purpose of this study is to report on the cost-effectiveness of surgical versus non-surgical treatment for ASLS using the as-treated data and provide a comparison to previously reported ITT analysis. Methods: Patients with at least 5-year follow-up data within the same treatment arm were included. Data collected every 3 months included use of nonoperative modalities, medications and employment status. Costs for surgeries and non-operative modalities were determined using Medicare Allowable rates. Medication costs were determined using the RedBook and indirect costs were calculated based on the reported employment status and income. Quality-Adjusted Life Years (QALY) was determined using the SF-6D. Results: Of 226 patients, 195 patients (73 Non-op, 122 Op) met inclusion criteria. At 5 years, 29 (24%) patients in the Op group had a revision surgery of whom two had two revisions and one had three revisions. The cumulative cost for the Op group was $111,451 with a cumulative QALY gain of 2.3. The cumulative cost for the Non-Op group was $29,124 with a cumulative QALY gain of 0.4. This results in an ICER of $44,033 in favor of Op treatment. Conclusion: This as-treated cost-effectiveness analysis demonstrates that surgical treatment for adult lumbar scoliosis becomes favorable at year-three, 1 year earlier than suggested by a previous intent-to-treat analysis. Level of evidence: II.
AB - Study design: Longitudinal comparative cohort. Objective: The purpose of this study is to report on the cost-effectiveness of surgical versus non-surgical treatment for Adult Symptomatic Lumbar Scoliosis (ASLS) using the as-treated data and provide a comparison to previously reported intent-to-treat (ITT) analysis. Summary of background data: Adult spinal deformity is a relatively prevalent condition for which surgical treatment has become increasingly common but concerns surrounding complications, revision rates and cost-effectiveness remain unresolved. Of these issues, cost-effectiveness is perhaps the most difficult to quantify as the requisite data is difficult to obtain. The purpose of this study is to report on the cost-effectiveness of surgical versus non-surgical treatment for ASLS using the as-treated data and provide a comparison to previously reported ITT analysis. Methods: Patients with at least 5-year follow-up data within the same treatment arm were included. Data collected every 3 months included use of nonoperative modalities, medications and employment status. Costs for surgeries and non-operative modalities were determined using Medicare Allowable rates. Medication costs were determined using the RedBook and indirect costs were calculated based on the reported employment status and income. Quality-Adjusted Life Years (QALY) was determined using the SF-6D. Results: Of 226 patients, 195 patients (73 Non-op, 122 Op) met inclusion criteria. At 5 years, 29 (24%) patients in the Op group had a revision surgery of whom two had two revisions and one had three revisions. The cumulative cost for the Op group was $111,451 with a cumulative QALY gain of 2.3. The cumulative cost for the Non-Op group was $29,124 with a cumulative QALY gain of 0.4. This results in an ICER of $44,033 in favor of Op treatment. Conclusion: This as-treated cost-effectiveness analysis demonstrates that surgical treatment for adult lumbar scoliosis becomes favorable at year-three, 1 year earlier than suggested by a previous intent-to-treat analysis. Level of evidence: II.
KW - As-treated analysis
KW - Cost-effectiveness
KW - Lumbar scoliosis
KW - Operative vs non-operative
UR - http://www.scopus.com/inward/record.url?scp=85087627716&partnerID=8YFLogxK
U2 - 10.1007/s43390-020-00154-w
DO - 10.1007/s43390-020-00154-w
M3 - Article
C2 - 32632890
AN - SCOPUS:85087627716
SN - 2212-134X
VL - 8
SP - 1333
EP - 1339
JO - Spine deformity
JF - Spine deformity
IS - 6
ER -