Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY 40204, USA.
Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY 40204, USA.
Spine J. 2020 Sep;20(9):1464-1470. doi: 10.1016/j.spinee.2020.03.018. Epub 2020 Apr 12.
Considerable debate exists regarding the optimal surgical approach for adult spinal deformity (ASD). It remains unclear which approach, posterior-only or combined anterior-posterior (AP), is more cost-effective. Our goal is to determine the 2-year cost per quality-adjusted life year (QALY) for each approach.
To compare the 2-year cost-effectiveness of surgical treatment for ASD between the posterior-only approach and combined AP approach.
Retrospective economic analysis of a prospective, multicenter database PATIENT SAMPLE: From a prospective, multicenter surgical database of ASD, patients undergoing five or more level fusions through a posterior-only or AP approach were identified and compared.
QALYs gained were determined using baseline, 1-year, and 2-year postoperative Short Form 6D. Cost was calculated from actual, direct hospital costs including any subsequent readmission or revision. Cost-effectiveness was determined using cost/QALY gained.
The AP approach showed significantly higher index cost than the posterior-only approach ($84,329 vs. $64,281). This margin decreased at 2-year follow-up with total costs of $89,824 and $73,904, respectively. QALYs gained at 2 years were similar with 0.21 and 0.17 in the posterior-only and the AP approaches, respectively. The cost/QALY at 2 years after surgery was significantly higher in the AP approach ($525,080) than in the posterior-only approach ($351,086).
We assessed 2-year cost-effectiveness for the surgical treatment through posterior-only and AP approaches. The posterior-only approach is less expensive both for the index surgery and at 2-year follow-up. The QALY gained at 2-years was similar between the two approaches. Thus, posterior-only approach was more cost-effective than the AP approach under our study parameters. However, both approaches were not cost-effective at 2-year follow-up.
成人脊柱畸形（ASD）的最佳手术方法存在很大争议。目前尚不清楚哪种方法（单纯后路或前后联合）更具成本效益。我们的目标是确定每种方法的每两年质量调整生命年（QALY）的成本。
比较后路和前后联合两种方法治疗 ASD 的两年成本效益。
前瞻性多中心数据库的回顾性经济分析
从 ASD 的前瞻性多中心手术数据库中，确定并比较了通过单纯后路或前后联合方法进行 5 个或更多节段融合的患者。
使用基线、1 年和 2 年术后简短形式 6 维度（Short Form 6D）确定获得的 QALY。成本是根据实际的直接医院成本计算的，包括任何随后的再入院或修正。使用成本/QALY 增益来确定成本效益。
前后联合方法的指数成本明显高于单纯后路方法（$84329 比 $64281）。在 2 年随访时，这一差距缩小，总成本分别为$89824 和 $73904。2 年时获得的 QALY 相似，分别为单纯后路和前后联合方法的 0.21 和 0.17。术后 2 年，前后联合方法的成本/QALY 显著高于单纯后路方法（$525080 比 $351086）。
我们评估了单纯后路和前后联合方法治疗的 2 年成本效益。单纯后路方法在索引手术和 2 年随访时都更便宜。两种方法在 2 年时获得的 QALY 相似。因此，在我们的研究参数下，单纯后路方法比前后联合方法更具成本效益。然而，在 2 年随访时，两种方法都没有成本效益。
