TY - JOUR
T1 - Surgical treatment of spinal stenosis with and without degenerative spondylolisthesis
T2 - Cost-effectiveness after 2 years
AU - Tosteson, Anna N.A.
AU - Lurie, Jon D.
AU - Tosteson, Tor D.
AU - Skinner, Jonathan S.
AU - Herkowitz, Harry
AU - Albert, Todd
AU - Boden, Scott D.
AU - Bridwell, Keith
AU - Longley, Michael
AU - Andersson, Gunnar B.
AU - Blood, Emily A.
AU - Grove, Margaret R.
AU - Weinstein, James N.
PY - 2008/12/16
Y1 - 2008/12/16
N2 - Background: The SPORT (Spine Patient Outcomes Research Trial) reported favorable surgery outcomes over 2 years among patients with stenosis with and without degenerative spondylolisthesis, but the economic value of these surgeries is uncertain. Objective: To assess the short-term cost-effectiveness of spine surgery relative to nonoperative care for stenosis alone and for stenosis with spondylolisthesis. Design: Prospective cohort study. Data Sources: Resource utilization, productivity, and EuroQol EQ-5D score measured at 6 weeks and at 3, 6, 12, and 24 months after treatment among SPORT participants. Target Population: Patients with image-confirmed spinal stenosis, with and without degenerative spondylolisthesis. Time Horizon: 2 years. Perspective: Societal. Intervention: Nonoperative care or surgery (primarily decompressive laminectomy for stenosis and decompressive laminectomy with fusion for stenosis associated with degenerative spondylolisthesis). Outcome Measures: Cost per quality-adjusted life-year (QALY) gained. Results of Base-Case Analysis: Among 634 patients with stenosis, 394 (62%) had surgery, most often decompressive laminectomy (320 of 394 [81%]). Stenosis surgeries improved health to a greater extent than nonoperative care (QALY gain, 0.17 [95% CI, 0.12 to 0.22]) at a cost of $77 600 (CI, $49 600 to $120 000) per QALY gained. Among 601 patients with degenerative spondylolisthesis, 368 (61%) had surgery, most including fusion (344 of 368 [93%]) and most with instrumentation (269 of 344 [78%]). Degenerative spondylolisthesis surgeries significantly improved health versus nonoperative care (QALY gain, 0.23 [CI, 0.19 to 0.27]), at a cost of $115 600 (CI, $90 800 to $144 900) per QALY gained. Result of Sensitivity Analysis: Surgery cost markedly affected the value of surgery. Limitation: The study used self-reported utilization data, 2-year time horizon, and as-treated analysis to address treatment nonadherence among randomly assigned participants. Conclusion: The economic value of spinal stenosis surgery at 2 years compares favorably with many health interventions. Degenerative spondylolisthesis surgery is not highly cost-effective over 2 years but could show value over a longer time horizon.
AB - Background: The SPORT (Spine Patient Outcomes Research Trial) reported favorable surgery outcomes over 2 years among patients with stenosis with and without degenerative spondylolisthesis, but the economic value of these surgeries is uncertain. Objective: To assess the short-term cost-effectiveness of spine surgery relative to nonoperative care for stenosis alone and for stenosis with spondylolisthesis. Design: Prospective cohort study. Data Sources: Resource utilization, productivity, and EuroQol EQ-5D score measured at 6 weeks and at 3, 6, 12, and 24 months after treatment among SPORT participants. Target Population: Patients with image-confirmed spinal stenosis, with and without degenerative spondylolisthesis. Time Horizon: 2 years. Perspective: Societal. Intervention: Nonoperative care or surgery (primarily decompressive laminectomy for stenosis and decompressive laminectomy with fusion for stenosis associated with degenerative spondylolisthesis). Outcome Measures: Cost per quality-adjusted life-year (QALY) gained. Results of Base-Case Analysis: Among 634 patients with stenosis, 394 (62%) had surgery, most often decompressive laminectomy (320 of 394 [81%]). Stenosis surgeries improved health to a greater extent than nonoperative care (QALY gain, 0.17 [95% CI, 0.12 to 0.22]) at a cost of $77 600 (CI, $49 600 to $120 000) per QALY gained. Among 601 patients with degenerative spondylolisthesis, 368 (61%) had surgery, most including fusion (344 of 368 [93%]) and most with instrumentation (269 of 344 [78%]). Degenerative spondylolisthesis surgeries significantly improved health versus nonoperative care (QALY gain, 0.23 [CI, 0.19 to 0.27]), at a cost of $115 600 (CI, $90 800 to $144 900) per QALY gained. Result of Sensitivity Analysis: Surgery cost markedly affected the value of surgery. Limitation: The study used self-reported utilization data, 2-year time horizon, and as-treated analysis to address treatment nonadherence among randomly assigned participants. Conclusion: The economic value of spinal stenosis surgery at 2 years compares favorably with many health interventions. Degenerative spondylolisthesis surgery is not highly cost-effective over 2 years but could show value over a longer time horizon.
UR - http://www.scopus.com/inward/record.url?scp=58049198325&partnerID=8YFLogxK
U2 - 10.7326/0003-4819-149-12-200812160-00003
DO - 10.7326/0003-4819-149-12-200812160-00003
M3 - Article
C2 - 19075203
AN - SCOPUS:58049198325
SN - 0003-4819
VL - 149
SP - 845
EP - 853
JO - Annals of internal medicine
JF - Annals of internal medicine
IS - 12
ER -