PMID- 25692370
OWN - NLM
STAT- MEDLINE
DCOM- 20150511
LR  - 20181202
IS  - 1524-4040 (Electronic)
IS  - 0148-396X (Linking)
VI  - 76 Suppl 1
DP  - 2015 Mar
TI  - Determination of the minimum improvement in pain, disability, and health state 
      associated with cost-effectiveness: introduction of the concept of minimum 
      cost-effective difference.
PG  - S64-70
LID - 10.1227/01.neu.0000462079.96571.dc [doi]
AB  - BACKGROUND: Minimum clinical important difference (MCID) has been adopted as the 
      smallest improvement in patient-reported outcome needed to achieve a level of 
      improvement thought to be meaningful to patients. OBJECTIVE: To use a common MCID 
      calculation method with a cost-utility threshold anchor to introduce the concept 
      of minimum cost-effective difference (MCED). METHODS: Forty-five patients 
      undergoing transforaminal lumbar interbody fusion for degenerative 
      spondylolisthesis were included. Outcome questionnaires were administered before 
      and 2 years after surgery. Total cost per quality-adjusted life-year (QALY) 
      gained was calculated for each patient. MCED was determined from 
      receiver-operating characteristic curve analysis with a cost-effective anchor of 
      < $50,000/QALY and < $75,000/QALY. MCID was determined with the health transition 
      item as the anchor. RESULTS: Significant improvement was observed 2 years after 
      transforaminal lumbar interbody fusion for all outcome measures. Mean total cost 
      per QALY gained at 2 years was $42,854. MCED was greater than MCID for each 
      outcome measure, meaning that a greater improvement was required to represent 
      cost-effectiveness than a clinically meaningful improvement to patients. The area 
      under the receiver-operating characteristic curve was consistently >/= 0.70 with 
      both cost-effective anchors, suggesting that outcome change scores were accurate 
      predictors of cost-effectiveness. Mean cost per QALY gained was significantly 
      lower for patients achieving compared with those not achieving an MCED in visual 
      analog scale for leg pain ($43,560 vs $112,087), visual analog scale for back 
      pain ($41,280 vs $129440), Oswestry Disability Index ($30,954 vs $121,750), and 
      EuroQol 5D ($35800 vs $189412). CONCLUSION: MCED serves as the smallest 
      improvement in an outcome instrument that is associated with a cost-effective 
      response to surgery. With the use of cost-effective anchor of < $50,000/QALY, 
      MCED after transforaminal lumbar interbody fusion was 4 points for visual analog 
      scale for low back pain, 3 points for visual analog scale for leg pain, 22 points 
      for Oswestry Disability Index, and 0.31 QALYs for EuroQol 5D.
FAU - Parker, Scott L
AU  - Parker SL
AD  - Department of Neurosurgery, Vanderbilt University Medical Center, and Vanderbilt 
      Spinal Column Surgical Quality and Outcomes Research Laboratory, Nashville, 
      Tennessee.
FAU - McGirt, Matthew J
AU  - McGirt MJ
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Neurosurgery
JT  - Neurosurgery
JID - 7802914
SB  - IM
MH  - Adult
MH  - Aged
MH  - Cohort Studies
MH  - Cost-Benefit Analysis
MH  - Female
MH  - Humans
MH  - Intervertebral Disc Degeneration/complications/*surgery
MH  - Low Back Pain/etiology/*surgery
MH  - Male
MH  - Middle Aged
MH  - Pain Measurement
MH  - Patient Outcome Assessment
MH  - Quality-Adjusted Life Years
MH  - Sensitivity and Specificity
MH  - Spinal Fusion/*economics
MH  - Spondylolisthesis/complications/*surgery
EDAT- 2015/02/19 06:00
MHDA- 2015/05/12 06:00
CRDT- 2015/02/19 06:00
PHST- 2015/02/19 06:00 [entrez]
PHST- 2015/02/19 06:00 [pubmed]
PHST- 2015/05/12 06:00 [medline]
AID - 00006123-201503001-00008 [pii]
AID - 10.1227/01.neu.0000462079.96571.dc [doi]
PST - ppublish
SO  - Neurosurgery. 2015 Mar;76 Suppl 1:S64-70. doi: 
      10.1227/01.neu.0000462079.96571.dc.