Cost-effectiveness Improves for Operative Versus Non-operative Treatment of Adult Symptomatic Lumbar Scoliosis at Eight-year Follow-up.
作者信息
Carreon Leah Y, Glassman Steven D, Smith Justin S, Kelly Michael P, Yanik Elizabeth L, Baldus Christine R, Lurie Jon D, Edwards Charles, Lenke Lawrence G, Buchowski Jacob M, Crawford Charles H, Koski Tyler, Lafage Virginie, Gupta Munish, Kim Han Jo, Ames Christopher P, Bess Shay, Schwab Frank J, Shaffrey Christopher I, Bridwell Keith H
机构信息
Norton Leatherman Spine Center, Louisville, KY.
Department of Neurosurgery, University of Virginia, Charlottesville, VA.
出版信息
Spine (Phila Pa 1976). 2025 May 1;50(9):586-592. doi: 10.1097/BRS.0000000000005186. Epub 2024 Oct 14.
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).
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