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
{"title":"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。","authors":"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","doi":"10.1097/BRS.0000000000005186","DOIUrl":null,"url":null,"abstract":"<p><strong>Study design: </strong>Secondary data analysis of the NIH-sponsored study on adult symptomatic lumbar scoliosis (ASLS).</p><p><strong>Objectives: </strong>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.</p><p><strong>Background: </strong>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.</p><p><strong>Materials and methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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).</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"586-592"},"PeriodicalIF":2.6000,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Cost-effectiveness Improves for Operative Versus Non-operative Treatment of Adult Symptomatic Lumbar Scoliosis at Eight-year Follow-up.\",\"authors\":\"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\",\"doi\":\"10.1097/BRS.0000000000005186\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Study design: </strong>Secondary data analysis of the NIH-sponsored study on adult symptomatic lumbar scoliosis (ASLS).</p><p><strong>Objectives: </strong>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.</p><p><strong>Background: </strong>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.</p><p><strong>Materials and methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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).</p>\",\"PeriodicalId\":22193,\"journal\":{\"name\":\"Spine\",\"volume\":\" \",\"pages\":\"586-592\"},\"PeriodicalIF\":2.6000,\"publicationDate\":\"2025-05-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Spine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/BRS.0000000000005186\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/10/14 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Spine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/BRS.0000000000005186","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/10/14 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
Cost-effectiveness Improves for Operative Versus Non-operative Treatment of Adult Symptomatic Lumbar Scoliosis at Eight-year Follow-up.
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).
期刊介绍：
Lippincott Williams & Wilkins is a leading international publisher of professional health information for physicians, nurses, specialized clinicians and students. For a complete listing of titles currently published by Lippincott Williams & Wilkins and detailed information about print, online, and other offerings, please visit the LWW Online Store.
Recognized internationally as the leading journal in its field, Spine is an international, peer-reviewed, bi-weekly periodical that considers for publication original articles in the field of Spine. It is the leading subspecialty journal for the treatment of spinal disorders. Only original papers are considered for publication with the understanding that they are contributed solely to Spine. The Journal does not publish articles reporting material that has been reported at length elsewhere.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
