PMID- 30544310
OWN - NLM
STAT- MEDLINE
DCOM- 20191212
LR  - 20191217
IS  - 1092-0684 (Electronic)
IS  - 1092-0684 (Linking)
VI  - 45
IP  - 6
DP  - 2018 Dec 1
TI  - Cost-effectiveness of adult spinal deformity surgery in a military healthcare 
      system.
PG  - E11
LID - 2018.9.FOCUS18381 [pii]
LID - 10.3171/2018.9.FOCUS18381 [doi]
AB  - OBJECTIVEAdult spinal deformity surgery is an effective way of treating pain and 
      disability, but little research has been done to evaluate the costs associated 
      with changes in health outcome measures. This study determined the change in 
      quality-adjusted life years (QALYs) and the cost per QALY in patients undergoing 
      spinal deformity surgery in the unique environment of a military healthcare 
      system (MHS).METHODSPatients were enrolled between 2011 and 2017. Patients were 
      eligible to participate if they were undergoing a thoracolumbar spinal fusion 
      spanning more than 6 levels to treat an underlying deformity. Patients completed 
      the 36-Item Short Form Health Survey (SF-36) prior to surgery and 6 and 12 months 
      after surgery. The authors used paired t-tests to compare SF-36 Physical 
      Component Summary (PCS) scores between baseline and postsurgery. To estimate the 
      cost per QALY of complex spine surgery in this population, the authors extended 
      the change in health-related quality of life (HRQOL) between baseline and 
      follow-up over 5 years. Data on the cost of surgery were obtained from the MHS 
      and include all facility and physician costs.RESULTSHRQOL and surgical data were 
      available for 49 of 91 eligible patients. Thirty-one patients met additional 
      criteria allowing for cost-effectiveness analysis. Over 12 months, patients 
      demonstrated significant improvement (p < 0.01) in SF-36 PCS scores. A majority 
      of patients met the minimum clinically important difference (MCID; 83.7%) and 
      substantive clinical benefit threshold (SCBT; 83.7%). The average change in QALY 
      was an increase of 0.08. Extended across 5 years, including the 3.5% discounting 
      per year, study participants increased their QALYs by 0.39, resulting in an 
      average cost per QALY of $181,649.20. Nineteen percent of patients met the < 
      $100,000/QALY threshold with half of the patients meeting the < $100,000/QALY 
      mark by 10 years. A sensitivity analysis showed that patients who scored below 60 
      on their preoperative SF-36 PCS had an average increase in QALYs of 0.10 per year 
      or 0.47 over 5 years.CONCLUSIONSWith a 5-year extended analysis, patients who 
      receive spinal deformity surgery in the MHS increased their QALYs by 0.39, with 
      19% of patients meeting the $100,000/QALY threshold. The majority of patients met 
      the threshold for MCID and SCBT at 1 year postoperatively. Consideration of 
      preoperative functional status (SF-36 PCS score < 60) may be an important factor 
      in determining which patients benefit the most from spinal deformity surgery.
FAU - Neal, Chris J
AU  - Neal CJ
AD  - 1Section of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, 
      Maryland.
FAU - Mandell, Kara
AU  - Mandell K
AD  - 2CNA Corporation, Arlington, Virginia.
FAU - Tasikas, Ellen
AU  - Tasikas E
AD  - 1Section of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, 
      Maryland.
FAU - Delaney, John J
AU  - Delaney JJ
AD  - 1Section of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, 
      Maryland.
FAU - Miller, Charles A
AU  - Miller CA
AD  - 1Section of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, 
      Maryland.
FAU - Schlaff, Cody D
AU  - Schlaff CD
AD  - 3George Washington University School of Medicine, Washington, DC; and.
FAU - Rosner, Michael K
AU  - Rosner MK
AD  - 4Department of Neurosurgery, George Washington University, Washington, DC.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Neurosurg Focus
JT  - Neurosurgical focus
JID - 100896471
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - *Cost-Benefit Analysis
MH  - *Delivery of Health Care
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Military Personnel/*statistics & numerical data
MH  - Postoperative Period
MH  - Quality of Life
MH  - Quality-Adjusted Life Years
MH  - Retrospective Studies
MH  - Scoliosis/*surgery
MH  - Spinal Fusion/methods
OTO - NOTNLM
OT  - CEA = cost-effectiveness acceptability
OT  - GDP = gross domestic product
OT  - HRQOL = health-related quality of life
OT  - MCID = minimum clinically important difference
OT  - MHS = military healthcare system
OT  - PCS = Physical Component Summary
OT  - QALY
OT  - QALY = quality-adjusted life year
OT  - SCBT = substantive clinical benefit threshold
OT  - SF-36 = 36-Item Short Form Health Survey
OT  - cost-effectiveness
OT  - military healthcare system
OT  - quality-adjusted life year
OT  - spinal deformity surgery
EDAT- 2018/12/14 06:00
MHDA- 2019/12/18 06:00
CRDT- 2018/12/15 06:00
PHST- 2018/08/01 00:00 [received]
PHST- 2018/09/10 00:00 [accepted]
PHST- 2018/12/15 06:00 [entrez]
PHST- 2018/12/14 06:00 [pubmed]
PHST- 2019/12/18 06:00 [medline]
AID - 2018.9.FOCUS18381 [pii]
AID - 10.3171/2018.9.FOCUS18381 [doi]
PST - ppublish
SO  - Neurosurg Focus. 2018 Dec 1;45(6):E11. doi: 10.3171/2018.9.FOCUS18381.