Cost-Utility Analysis of Surgery and Radiotherapy for Symptomatic Spinal Metastases in a Belgian Specialist Center

Depreitere, Bart; Turner, Isobel; Vandoren, Cindy; Choi, David

doi:10.1016/j.wneu.2019.01.130

Cited by 11 publications

(15 citation statements)

References 23 publications

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“…While prior studies with a high proclivity for confounding by indication maintained an association between surgical intervention and survival, [13][14][15] such a link was not observed in our cohort. The overall mortality rate for our cohort at both 1-and 2 years is aligned with other work, such as that of Ghori et al, 10 Turner et al, 14 and the prospective series of Fehlings et al 20 In studies that have accounted for selection bias for surgery using causal inference techniques, or other statistical approaches, the survival benefit associated with surgery has been marginal at most and usually only realized over the course of the first 6 months following treatment.…”

Section: Discussioncontrasting

confidence: 83%

“…5,11 Over the last 15 years, surgical treatment has been touted as a means to preserve functional independence, quality of life, and improve the prospect for survival. 4,5,[12][13][14][15] A balanced assessment of the literature supporting these notions, however, raises concern for both selection bias and confounding by indication. Nonrandomized clinical series were limited as only patients with favorable survival characteristics were eligible for surgery, while those who would not tolerate surgical intervention, or who were deemed poor candidates, received palliative nonoperative care.…”

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confidence: 99%

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A Natural History of Patients Treated Operatively and Nonoperatively for Spinal Metastases Over 2 Years Following Treatment

Xiong

Fisher

Schwab

et al. 2022

Spine

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Study Design. Prospective observational study. Objective. We present the natural history, including survival and function, among participants in the prospective observational study of spinal metastases treatment investigation. Summary of Background Data. Surgical treatment has been touted as a means to preserve functional independence, quality of life, and survival. Nearly all prior investigations have been limited by retrospective design and relatively short-periods of post-treatment surveillance.Methods. This natural history study was conducted using the records of patients who were enrolled in the prospective observational study of spinal metastases treatment study (2017)(2018)(2019). Eligible participants were 18 or older and presenting for treatment of spinal metastatic disease. Patients were followed at predetermined intervals (1, 3, 6, 12, and 24-mo) following treatment. We conducted cox proportional hazard regression analysis adjusting for confounders including age, biologic sex, number of comorbidities, type of metastatic lesion, neurologic symptoms at presentation, number of metastases involving the vertebral body, vertebral body collapse, New England Spinal Metastasis Score (NESMS) at presentation, and treatment strategy. Results. We included 202 patients. Twenty-three percent of the population had died by 3 months following treatment initiation, 51% by 1 year, and 70% at 2 years. There was no significant difference in survival between patients treated operatively and nonoperatively (P ¼ 0.16). No significant difference in HRQL between groups was appreciated beyond 3 months following treatment initiation. NESMS at presentation (scores of 0 [HR 5.61; 95% CI 2.83, 11.13] and 1 [HR 3.00; 95% CI 1.60, 5.63]) was significantly associated with mortality. Conclusion. We found that patients treated operatively and nonoperatively for spinal metastases benefitted from treatment in terms of HRQL. Two-year mortality for the cohort as a whole was 70%. When prognosticating survival, the NESMS appears to be an effective utility, particularly among patients with scores of 0 or 1.

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Section: Discussioncontrasting

confidence: 83%

mentioning

confidence: 99%

A Natural History of Patients Treated Operatively and Nonoperatively for Spinal Metastases Over 2 Years Following Treatment

Xiong

Fisher

Schwab

et al. 2022

Spine

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“…In Japan, Miyazaki et al [ 2 ] also found surgical treatment to be cost-effective with an ICER of 42,003 USD per QALY gained at a WTP of 50,000 USD per QALY gained. Finally–in Belgium, Depreitere et al [ 7 ]. Reported an ICER for surgical management of spinal metastasis of 13,635 EUR per QALY compared to radiotherapy alone.…”

Section: Discussionmentioning

confidence: 99%

“…CUA studies that compared surgical treatment and radiotherapy alone for the treatment of spinal metastasis have been reported in Japan, the United Kingdom, Belgium, Canada, and the United States. The results of those studies showed combination surgery and radiotherapy to be cost-effective compared to radiotherapy alone for treating spinal metastasis in developed countries [ 2 , 7 - 10 ].…”

Section: Introductionmentioning

confidence: 99%

Cost-Utility Analysis Compared Between Radiotherapy Alone and Combined Surgery and Radiotherapy for Symptomatic Spinal Metastases in Thailand

et al. 2022

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Objective: To investigate the patient quality of life and cost-utility compared between radiotherapy alone and combined surgery and radiotherapy for spinal metastasis (SM) in Thailand.Methods: Patients with SM with an indication for surgery during 2018–2020 were prospectively recruited. Patients were assigned to either the combination surgery and radiotherapy group or the radiotherapy alone group. Quality of life was assessed by EuroQol-5D-5L (EQ-5D-5L) questionnaire, and relevant healthcare costs were collected pretreatment, and at 3-month and 6-month posttreatment. Total lifetime cost and quality-adjusted life-years (QALYs) were estimated for each group.Results: Twenty-four SM patients (18 females, 6 males) were included. Of those, 12 patients underwent combination treatment, and 12 underwent radiotherapy alone. At 6-month posttreatment, 10 patients in the surgery group, and 11 patients in the nonsurgery group remained alive for a survival rate of 83.3% and 91.7%, retrospectively. At 6-month posttreatment, the mean utility in the combination treatment group was significantly better than in the radiotherapy alone group (0.804 ± 0.264 vs. 0.518 ± 0.282, respectively; p = 0.011). Total lifetime costs were 59,863.14 United States dollar (USD) in the combination treatment group and 24,526.97 USD in the radiation-only group. The incremental cost-effectiveness ratio using 6-month follow-up data was 57,074.01 USD per QALY gained.Conclusion: Surgical treatment combined with radiotherapy to treat SM significantly improved patient quality of life compared to radiotherapy alone during the 6-month posttreatment period. However, combination treatment was found not to be cost-effective compared to radiotherapy alone for SM at the Thailand willingness-to-pay threshold of 5,113 USD/QALY.

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“…11 Cost involved in spine tumor metastatic surgery have been looked in few studies globally. [12][13][14][15] With prolonged life expectancy, the overall cost of cancer treatment incurred can be manifolds. Significant efforts are being made to make spine surgery cost effective without compromising outcomes.…”

Section: Introductionmentioning

confidence: 99%

Cost Analysis With Use of Expandable Cage or Cement in Single level Thoracic Vertebrectomy in Metastasis

Katzir

Rustagi

Hatef

et al. 2020

Global Spine Journal

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Study Design: Retrospective case series. Objective: Patient with metastatic cancer frequently require spinal operations for neural decompression and stabilization, most commonly thoracic vertebrectomy with reconstruction. Objective of the study was to assess economic aspects associated with use of cement versus expandable cage in patients with single level thoracic metastatic disease. We also looked at the differences in the clinical, radiological, complications and survival differences to assess non-inferiority of PMMA over cages. Methods: The electronic medical records of patients undergoing single level thoracic vertebrectomy and reconstruction were reviewed. Two groups were made: PMMA and EC. Totals surgical cost, implant costs was analyzed. We also looked at the clinical/ radiological outcome, complication and survival analysis. Results: 96 patients were identified including 70 one-level resections. For 1-level surgeries, Implant costs for use of cement—$75 compared to $9000 for cages. Overall surgical cost was significantly less for PMMA compared to use of EC. No difference was seen in clinical outcome or complication was seen. We noticed significantly better kyphosis correction in the PMMA group. Conclusions: Polymethylmethacrylate cement offers significant cost advantage for reconstruction after thoracic vertebrectomy. It also allows for better kyphosis correction and comparable clinical outcomes and non-inferior to cages.

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Cost-Utility Analysis of Surgery and Radiotherapy for Symptomatic Spinal Metastases in a Belgian Specialist Center

Cited by 11 publications

References 23 publications

A Natural History of Patients Treated Operatively and Nonoperatively for Spinal Metastases Over 2 Years Following Treatment

A Natural History of Patients Treated Operatively and Nonoperatively for Spinal Metastases Over 2 Years Following Treatment

Cost-Utility Analysis Compared Between Radiotherapy Alone and Combined Surgery and Radiotherapy for Symptomatic Spinal Metastases in Thailand

Cost Analysis With Use of Expandable Cage or Cement in Single level Thoracic Vertebrectomy in Metastasis

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