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  • Cost-Utility Analysis of Surgical Treatment for Adult Spinal Deformity

    Final Number:

    Ian McCarthy PhD; Michael F. OBrien MD; Christopher P. Ames MD; Thomas Errico; Justin S. Smith MD PhD; Han Jo Kim MD; Gregory Mundis MD; Frank Schwab MD, PhD; Eric Klineberg MD; Christopher I. Shaffrey MD, FACS; Munish Gupta MD; Richard A. Hostin MD; International Spine Study Group

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2013 Annual Meeting

    Introduction: Cost-utility analysis is critical to the efficient allocation of health care resources. The current study examines the cost-effectiveness of surgical treatment of adult spinal deformity (ASD) with extended follow-up on observed costs, payments, and QALYs following primary surgery, including any related readmissions.

    Methods: Single-center, retrospective analysis of consecutive patients undergoing primary surgery for ASD. Payments (expressed in 2010 dollars) to the hospital were collected from administrative data, with QALYs calculated from the SF-6D. Payments and QALYs were discounted at 3.5% per year. The study analyzed the average cost-effectiveness ratio (ACER) and a range of incremental cost-effectiveness ratios (ICERs) based on improvement in QALYs from baseline and alternative assumptions of the reduction in HRQOL without surgical intervention. Results were projected through 10-year follow-up, and 95% confidence intervals (CIs) were calculated using nonparametric bootstrap methods.

    Results: Three-year follow-up was available for 239 of 278 eligible patients (86%), which were predominantly female (n=203, 85%) with average age of 49 (range 18 to 82). Total per-patient payments averaged $211,529, including any readmissions over the follow-up period. Discounted QALYs averaged 1.9 over 3-year follow-up. Projecting through 10-year follow-up, the ACER ($/QALY) was $37,973. ICERs ranged from $58,027 based on an assumed 20% reduction in quality-of-life per year without surgery to $357,950 assuming no reduction in quality-of-life without surgery.

    Conclusions: This study considers the cost-effectiveness of surgical treatment for ASD with a range of assumptions regarding the reduction in HRQOL without surgery. The results illustrate the potential for ASD surgery to be highly cost-effective provided accurate identification of patients likely to deteriorate in HRQOL without surgery. Future research should pursue direct measurement of the incremental improvement in QALYs attributed to surgery as well as outpatient resource utilization and indirect costs/benefits resulting from changes in absenteeism or productivity at work.

    Patient Care: Improve our understanding of the economics of providing care for spine patients.

    Learning Objectives: By the conclusion of this session, participants should be able to: (1) Understand the concept of quality-adjusted life-years (QALYs); (2) Appreciate the potential for adult spinal deformity surgery to be cost-effective, especially among patients likely to deteriorate in health-related quality of life without surgery; (3) Appreciate the importance of future research on the cost-effectiveness of surgery for adult spinal deformity.


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