Kim Andrew H, ElNemer William, Greenberg Marc, Raad Micheal, Kebaish Khaled M
Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N Caroline St. 5th Floor, Baltimore, MD, 21205, USA.
Spine Deform. 2025 Apr 11. doi: 10.1007/s43390-025-01070-7.
To determine the viability of preoperative bone health optimization for the prevention of revision surgery due to osteoporosis among adult spinal deformity (ASD) patients using break-even economic modeling.
The cost of a DXA scan and total 2-year cost of revision ASD surgery were obtained from institutional records. 2-Year ASD revision rates among patients with osteoporosis were obtained from the literature. An open-access database was used to determine the mean retail price for Teriparatide, Denosumab, and Zoledronic acid. Total optimization costs included the costs of a DXA scan and medication treatment. Costs were adjusted for inflation using the Consumer Price Index to 2023 U.S. dollars. A break-even economic analysis was performed to determine the absolute risk reduction (ARR) and number needed to treat (NNT) to economically justify each treatment.
DXA scan ($349.28) and revision ASD surgery ($147,731.78) costs were obtained from institutional records. The cost of optimizing patients with DXA and Teriparatide, Denosumab, and Zoledronic acid was $4,410.32, $3,832.78, and $1,552.61, respectively. Each treatment modality was cost-effective at all revision ASD surgery rates. Teriparatide was economically justified if the initial revision rate decreased by 2.99% (NNT = 34), Denosumab by 2.59% (NNT = 39), and Zoledronic acid by 1.05% (NNT = 96).
Preoperative bone health optimization among ASD patients undergoing surgery is highly cost-effective in the prevention of revision surgery due to osteoporosis. Teriparatide would need to prevent 1 revision surgery out of 34 ASD surgeries, Denosumab 1 out of 39, and Zoledronic acid 1 out of 96 to break-even on costs.
采用盈亏平衡经济模型，确定术前优化骨骼健康对于预防成人脊柱畸形（ASD）患者因骨质疏松症而进行翻修手术的可行性。
从机构记录中获取双能X线吸收法（DXA）扫描的费用以及ASD翻修手术的2年总费用。从文献中获取骨质疏松症患者的2年ASD翻修率。使用一个开放获取数据库来确定特立帕肽、地诺单抗和唑来膦酸的平均零售价。总的优化成本包括DXA扫描和药物治疗的费用。使用消费者价格指数将成本调整为2023年美元以考虑通货膨胀因素。进行盈亏平衡经济分析以确定每种治疗在经济上合理的绝对风险降低率（ARR）和需治疗人数（NNT）。
DXA扫描费用（349.28美元）和ASD翻修手术费用（147,731.78美元）来自机构记录。使用DXA联合特立帕肽、地诺单抗和唑来膦酸对患者进行优化的成本分别为4,410.32美元、3,832.78美元和1,552.61美元。在所有ASD翻修手术率下，每种治疗方式都具有成本效益。如果初始翻修率降低2.99%（NNT = 34），特立帕肽在经济上是合理的；地诺单抗降低2.59%（NNT = 39）；唑来膦酸降低1.05%（NNT = 96）。
对于接受手术的ASD患者，术前优化骨骼健康在预防因骨质疏松症导致的翻修手术方面具有很高的成本效益。特立帕肽需要在34例ASD手术中预防1例翻修手术才能实现成本盈亏平衡，地诺单抗为39例中预防1例，唑来膦酸为96例中预防1例。
