A cost-utility analysis between decompression only and fusion surgery for elderly patients with lumbar spinal stenosis and sagittal imbalance

Won, Young Il; Kim, Chi Heon; Park, Hee Pyoung; Chung, Sun Gun; Yuh, Woon Tak; Kwon, Shin Won; Yang, Seung Heon; Lee, Chang‐Hyun; Choi, Yunhee; Park, Sung Bae; Rhee, John M.; Kim, Kyoung‐Tae; Chung, Chun Kee

doi:10.1038/s41598-022-24784-4

Cited by 5 publications

(3 citation statements)

References 49 publications

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“…They will be used in a separate study to develop evidence-based recommendations for economic evaluations in spine surgery. Finally, a total of 130 clinical cost-effectiveness studies were included 24–153…”

Section: Resultsmentioning

confidence: 99%

Methodology of economic evaluations in spine surgery: a systematic review and qualitative assessment

et al. 2023

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ObjectivesThe present study is a systematic review conducted as part of a methodological approach to develop evidence-based recommendations for economic evaluations in spine surgery. The aim of this systematic review is to evaluate the methodology and quality of currently available clinical cost-effectiveness studies in spine surgery.Study designSystematic literature review.Data sourcesPubMed, Web of Science, Embase, Cochrane, Cumulative Index to Nursing and Allied Health Literature, EconLit and The National Institute for Health Research Economic Evaluation Database were searched through 8 December 2022.Eligibility criteria for selecting studiesStudies were included if they met all of the following eligibility criteria: (1) spine surgery, (2) the study cost-effectiveness and (3) clinical study. Model-based studies were excluded.Data extraction and synthesisThe following data items were extracted and evaluated: pathology, number of participants, intervention(s), year, country, study design, time horizon, comparator(s), utility measurement, effectivity measurement, costs measured, perspective, main result and study quality.Results130 economic evaluations were included. Seventy-four of these studies were retrospective studies. The majority of the studies had a time horizon shorter than 2 years. Utility measures varied between the EuroQol 5 dimensions and variations of the Short-Form Health Survey. Effect measures varied widely between Visual Analogue Scale for pain, Neck Disability Index, Oswestry Disability Index, reoperation rates and adverse events. All studies included direct costs from a healthcare perspective. Indirect costs were included in 47 studies. Total Consensus Health Economic Criteria scores ranged from 2 to 18, with a mean score of 12.0 over all 130 studies.ConclusionsThe comparability of economic evaluations in spine surgery is extremely low due to different study designs, follow-up duration and outcome measurements such as utility, effectiveness and costs. This illustrates the need for uniformity in conducting and reporting economic evaluations in spine surgery.

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Section: Resultsmentioning

confidence: 99%

Methodology of economic evaluations in spine surgery: a systematic review and qualitative assessment

et al. 2023

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“…Our results also extend those of Alvin et al, 42 who, in a single-institutional cohort of patients undergoing DA or DF (further stratified by type of fusion), also found that each subtype of DF had an ICER greater than $800,000 USD or was strongly dominated by DA over a one-year time horizon. Finally, in a single-institutional assessment of 71 patients undergoing DA or DF in South Korea, Won et al , 43 estimated an ICER of $49,833 over a two-year time horizon. These results are not directly comparable with our own—patients in this study met criteria for LSS and sagittal-plane deformity and therefore may represent a subset of LSS patients who would not be well served with DA alone.…”

Section: Discussionmentioning

confidence: 99%

Lumbar Decompression With and Without Fusion for Lumbar Stenosis With Spondylolisthesis

Sastry,

Levy,

Chen

et al. 2024

Spine

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Study Design. Markov model Objective. To compare the cost-effectiveness of lumbar decompression alone (DA) with lumbar decompression with fusion (DF) for the management of adults undergoing surgery for lumbar stenosis with associated degenerative spondylolisthesis. Summary of Background Data. Rates of lumbar fusion have increased for all indications in the United States over the last 20 years. Recent randomized controlled trial data, however, have suggested comparable functional outcomes and lower reoperation rates for lumbar decompression and fusion as compared to lumbar decompression alone in the treatment of lumbar stenosis with degenerative spondylolisthesis. Materials and Methods. A multi-state Markov model was constructed from the U.S. payer perspective of a hypothetical cohort of patients with LSS requiring surgery. Data regarding clinical improvement, costs, and reoperation were generated from contemporary randomized trial evidence, meta-analyses of recent prospective studies, and large retrospective cohorts. Base case, one-way sensitivity analysis, and probabilistic sensitivity analyses were conducted and results were compared to a willingness to pay threshold of $100,000 (in 2022 USD) over a 2-year time horizon. A discount rate of 3% was utilized. Results. The incremental cost and utility of decompression with fusion relative to decompression alone were $12,778 and 0.00529 QALYs. The corresponding ICER of $2,416,281 far exceeded a willingness to pay threshold of $100,000. In sensitivity analysis, the results varied the most with respect to rate of improvement after lumbar decompression alone, rate of improvement after lumbar decompression and fusion, and odds ratio of reoperation between the two groups. 0% of one-way and probabilistic sensitivity analyses achieved cost-effectiveness at the willingness to pay threshold. Conclusions. Within the context of contemporary surgical data, DF is not cost effective compared with DA in the surgical management of LSS over a 2-year time horizon.

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“…However, extreme care should be taken not to decide on a surgical formula based on diagnosis from static imaging alone [ 8 ]. Decision-making and treatment options for LSS with sagittal imbalance are still controversial [ 9 ]. In fact, significant improvement of sagittal spinopelvic alignment has been known after simple lumbar decompression surgery for LSS [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Comparative Study for Characteristics of Locomotive Syndrome in Patients with Lumbar Stenosis and Adult Spinal Deformity

Ohba

Goto

Oda

et al. 2023

JCM

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Introduction: The differential diagnoses of lumbar spinal stenosis (LSS) and adult spinal deformity (ASD) have been demonstrated primarily using sagittal radiographic spinopelvic parameters. However, it is more important to know the differences in the characteristic clinical symptoms to make accurate treatment decisions. Recently, the relationship between spinal disease and Locomotive Syndrome (LS) has been reported. Additionally, the Geriatric Locomotive Function Scale-25 (GLFS-25) was reported to be a useful scale to evaluate disease severity and characteristic clinical symptoms in spinal disease. Methods: Sixty-nine consecutive patients with ASD and 196 patients with LSS who underwent spinal surgery were included. Locomotive dysfunction was evaluated using the GLFS-25 questionnaire and physical performance tests including the two-step test and the stand-up test, measured preoperatively. The correlations between sagittal spinopelvic parameters of ASD and LS were examined. Results: All subjects with lumbar degenerative disease in the present study were diagnosed with LS preoperatively. The severity of LS in patients with LSS and ASD were statistically similar. GLFS-25 scores in the mobility and community domain were similarly poor in both groups. Several scores in the domestic life and self-care domains were significantly worse in the ASD group. Question 20 of the GLFS-25, related to load-bearing tasks and housework, was significantly associated with a large pelvic incidence in ASD patients. Conclusions: Lumbar degenerative disease requiring surgery severely affects the LS of older people. ASD patients had more difficulty with load-bearing tasks and housework such as cleaning the yard, carrying heavy bedding, dressing, and bathing compared to LSS patients.

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A cost-utility analysis between decompression only and fusion surgery for elderly patients with lumbar spinal stenosis and sagittal imbalance

Cited by 5 publications

References 49 publications

Methodology of economic evaluations in spine surgery: a systematic review and qualitative assessment

Methodology of economic evaluations in spine surgery: a systematic review and qualitative assessment

Lumbar Decompression With and Without Fusion for Lumbar Stenosis With Spondylolisthesis

Comparative Study for Characteristics of Locomotive Syndrome in Patients with Lumbar Stenosis and Adult Spinal Deformity

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