Comparative Effectiveness Evidence From the Spine Patient Outcomes Research Trial

Abstract

Study Design Cost-effectiveness analysis of a randomized plus observational cohort trial Objective Analyze cost-effectiveness of Spine Patient Outcomes Research Trial (SPORT) data over 4 years comparing surgery with non-operative care for three common diagnoses: spinal stenosis (SpS), degenerative spondylolisthesis (DS) and intervertebral disc herniation (IDH). Summary of Background Data Spine surgery rates continue to rise in the US, but the safety and economic value of these procedures remains uncertain. Methods Patients with image-confirmed diagnoses were followed in randomized or observational cohorts with data on resource use, productivity and EQ-5D health state values measured at 6 weeks, 3, 6, 12, 24, 36, and 48 months. For each diagnosis, cost per quality-adjusted life year (QALY) gained in 2004 US Dollars was estimated for surgery relative to non-operative care using a societal perspective, with costs and QALYs discounted at 3% per year. Results Surgery was performed initially or during the 4-year follow-up among 414/634 (65.3%) SPS, 391/601 (65.1%) DS and 789/1192 (66.2%) IDH patients. Surgery improved health, with persistent QALY differences observed through 4 years (SpS QALY gain 0.22; 95%CI: 0.15, 0.34; DS QALY gain 0.34, 95%CI: 0.30, 0.47; IDH QALY gain 0.34, 95%CI: 0.31, 0.38). Costs per QALY gained decreased for SPS from $77,600 at 2 years to $59,400 (95%CI: $37,059, $125,162) at 4 years; for DS from $115,600 to $64,300/QALY (95%CI: $32,864, $83,117); and for IDH from $34,355 to $20,600/QALY (95%CI: $4,539, $33,088). Conclusions Comparative effectiveness evidence for clearly defined diagnostic groups from SPORT shows good value for surgery compared with non-operative care over 4-years.

Surgery or physical activity in the management of sciatica: a systematic review and meta-analysis

“…A recent systematic review showed spinal surgery to be a cost-effective treatment for sciatica, with cost-effectiveness increasing over time despite the different surgical interventions and spinal diagnoses [56]. Specifically, the Spine Patient Outcomes Research Trial (SPORT) showed progressively improved cost-effectiveness ratios over a 2-to 4-year period, with the mean cost per quality-adjusted life year (QALY) gained reducing from $34,355 to $20,600 for disc herniation, $77,600 to $59,400 for spinal stenosis and [57]. In comparison to non-surgical care, surgery appears to be cost effective despite the initial higher (surgical procedure) costs, [37] although fewer recurrences, less permanent disability benefits and absenteeism [58] resulted in the total cost for surgery being lower than non-surgical treatments [59].…”

European Pain Management Discussion Forum

“…Severe and painful spinal stenosis is one of the few very good indications for back surgery for pain 1. This patient has symptoms of quite severe central spinal stenosis and should have surgery soon.…”

Qualidade de vida relacionada à saúde e expectativas com o tratamento cirúrgico de pacientes com estenose espinhal: comparação segundo o local da estenose

“…Nos estudos internacionais observamos que a maioria dos participantes possuía pelo menos ensino médio completo, ou então, iniciando suas atividades em graduação (KURD, et al, 2012;LUO, et al, 2004;TOSTESON, et al, 2011).…”

“…Contudo, também encontramos estudos que observaram que grande parte de sua amostra desempenhava atividades remuneradas normais ( VAN HOOFF, et al, 2014;MANCUSO, et al, 2013;TOSTESON, et al, 2011).…”

“…Em estudos internacionais as comorbidades mais frequentes foram artrite, hipertensão, diabetes e doenças cardíacas (GODIL, et al, 2013;KURD, et al, 2012 Na literatura nacional e internacional, dentre as doenças degenerativas que afetam a coluna vertebral, a estenose espinhal tem baixa incidência comparada com outras doenças, como por exemplo, hérnia de disco, espondilolistese degenerativa, mielopatia e escoliose idiopática (LATTING, et al, 2013;BECHARA, et al, 2013;TOSTESON, et al, 2011). E dentro da estenose espinhal a prevalência de um indivíduo possuir estenose na região cervical é ainda menor, assim como observamos em nosso estudo.…”