Andrew H Kim, William ElNemer, Marc Greenberg, Micheal Raad, Khaled M Kebaish
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引用次数: 0
Abstract
Purpose: 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.
Methods: 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.
Results: 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).
Conclusion: 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.
期刊介绍：
Spine Deformity the official journal of the?Scoliosis Research Society is a peer-refereed publication to disseminate knowledge on basic science and clinical research into the?etiology?biomechanics?treatment?methods and outcomes of all types of?spinal deformities. The international members of the Editorial Board provide a worldwide perspective for the journal's area of interest.The?journal?will enhance the mission of the Society which is to foster the optimal care of all patients with?spine?deformities worldwide. Articles published in?Spine Deformity?are Medline indexed in PubMed.? The journal publishes original articles in the form of clinical and basic research. Spine Deformity will only publish studies that have institutional review board (IRB) or similar ethics committee approval for human and animal studies and have strictly observed these guidelines. The minimum follow-up period for follow-up clinical studies is 24 months.
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