Cost-Effectiveness of Surgical Treatment for Adult Spinal Deformity: A Comparison of Dollars per Quality of Life Improvement Across Health Domains

Ian McCarthy; Richard Hostin; Michael O'Brien; Neil Fleming; Gerald Ogola; Rustam Kudyakov; Kathleen Richter; Rajiv Saigal; Sigurd Berven; Vedat Deviren; Christopher Ames; International Spine Study Group

doi:10.1016/j.jspd.2013.05.007

Cost-Effectiveness of Surgical Treatment for Adult Spinal Deformity: A Comparison of Dollars per Quality of Life Improvement Across Health Domains

Spine Deform. 2013 Jul;1(4):293-298. doi: 10.1016/j.jspd.2013.05.007. Epub 2013 Aug 2.

Affiliations

¹ Institute for Health Care Research and Improvement, Baylor Health Care System, 8080 N. Central Expressway, Suite 500, Dallas, TX 75248, USA; Southern Methodist University, Dallas, TX, USA. Electronic address: ianmccarthy.econ@gmail.com.
² Baylor Scoliosis Center, Plano, TX, USA.
³ Institute for Health Care Research and Improvement, Baylor Health Care System, 8080 N. Central Expressway, Suite 500, Dallas, TX 75248, USA.
⁴ University of California San Francisco, San Francisco, CA, USA.
⁵ Denver, CO, USA.

PMID: 27927361
DOI: 10.1016/j.jspd.2013.05.007

Abstract

Design: Retrospective, single-center analysis of consecutive patients undergoing surgical treatment for adult spinal deformity (ASD).

Objective: Assess the value of surgical treatment for ASD across different health domains.

Summary of background data: The cost of improvement in health-related quality of life (HRQOL) is an important consideration for resource allocation. There is also growing concern among policy makers regarding the incorporation of patient-specific preferences in the appropriate definition and assessment health care value.

Methods: Single-center, retrospective study of consecutive ASD patients undergoing primary surgery with principal diagnosis code 737.0-737.9 from 2005 through May 2010. Patients less than 18 years of age were excluded. The HRQOL measures were based on the Short Form-36, the Oswestry Disability Index (ODI), and the Scoliosis Research Society (SRS)-22 questionnaire after at least 2 years after surgery. The SRS scores were translated to a 100-point scale. Costs were collected from hospital data on the total costs incurred for the episode of surgical care. Confidence intervals were calculated using nonparametric bootstrap methods.

Results: Baseline and minimum 2-year HR follow-up data were available for 164 patients, with an average follow-up of 3.2 years and a range of 2 to 7.4 years. Patients were predominantly female (14; 88%) and ranged from 18 to 82 years of age at index surgery (average of 51 years of age). The cost-effectiveness (CE) ratios varied across different HRQOL outcomes, ranging from an average cost of $5,658 per 1-point improvement in SRS Self-image to an average cost of $25,918 per 1-point improvement in SF-36 Physical Component Score (PCS). Results revealed statistically significant differences (p < .05) in CE ratios across different HRQOL outcomes.

Conclusions: Statistically significant differences were found in CE ratios across HRQOL sub-domains. This has important implications in the assessment of patient-specific value of health care services, and illustrates that surgical treatment for ASD may be more cost-effective for some purposes (eg, pain reduction) and less cost-effective for others (eg, improved functional activity).

Keywords: Adult spinal deformity; Cost-effectiveness; Health care value; Health-related quality of life; Patient-specific preferences.