Cost-effectiveness Improves for Operative Versus Non-operative Treatment of Adult Symptomatic Lumbar Scoliosis at Eight-year Follow-up.

IF 2.6 2区医学 Q2 CLINICAL NEUROLOGY

Spine Pub Date : 2025-05-01 Epub Date: 2024-10-14 DOI:10.1097/BRS.0000000000005186

Leah Y Carreon, Steven D Glassman, Justin S Smith, Michael P Kelly, Elizabeth L Yanik, Christine R Baldus, Jon D Lurie, Charles Edwards, Lawrence G Lenke, Jacob M Buchowski, Charles H Crawford, Tyler Koski, Virginie Lafage, Munish Gupta, Han Jo Kim, Christopher P Ames, Shay Bess, Frank J Schwab, Christopher I Shaffrey, Keith H Bridwell

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Abstract

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).

查看原文本刊更多论文

成人症状性腰椎脊柱侧凸手术治疗与非手术治疗的成本效益在八年随访中得到改善。

研究设计：对美国国立卫生研究院（NIH）赞助的成人症状性腰椎侧弯症（ASLS）研究进行二次数据分析：本研究旨在对入组八年后的ASLS手术治疗与非手术治疗进行成本效益分析比较：之前对当前队列进行的成本效益分析显示，入组五年后手术治疗与非手术治疗的ICER分别为44,033美元和27,480美元：前两年每三个月收集一次数据，随后每六个月收集一次数据。数据包括非手术方式、药物和就业状况的使用情况。指数手术、翻修手术和非手术方式的费用根据医疗保险的允许费率确定。药物成本使用红皮书确定，间接成本根据报告的就业状况和收入计算。质量调整生命年（QALY）使用 SF6D 确定：手术（Op）组有 101 例，非手术（Non-Op）组有 103 例，均有完整的八年数据。非手术组中有 38 名患者（37%）在入组后 3 至 72 个月内接受了手术。治疗分析只包括从未接受过手术的病例（N=65）或有完整八年术后数据的病例（N=101），结果显示手术治疗更受青睐，每 QALY 收益的 ICER 为 20,569 美元，在支付意愿（WTP）阈值之内。意向治疗分析显示，手术组的 QALY 收益更高，成本更低（ICER = 13,911 美元）。然而，意向治疗分析受到非手术患者的影响，他们在随访期间的不同时间转为手术治疗：结论：在八年的随访中，ASLS 的手术治疗比非手术治疗更具成本效益。与五年值相比，ICER继续提高（20,569美元对44,033美元）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Spine 医学-临床神经学

CiteScore

5.90

自引率

6.70%

发文量

361

审稿时长

6.0 months

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