Is surgery for cervical spondylotic myelopathy cost-effective? A cost-utility analysis based on data from the AOSpine North America prospective CSM study

Fehlings, Michael G.; Jha, Neilank K.; Hewson, Stephanie M.; Massicotte, Eric M.; Kopjar, Branko; Kalsi‐Ryan, Sukhvinder

doi:10.3171/2012.6.aospine111069

Cited by 60 publications

(44 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…42 We used the derived SF-6D values to calculate QALYs gained, which is a validated approach in cost-utility analyses. 23 However, Obradovic et al 37 observed that EQ-5D might have a greater mean change from baseline to end point compared with SF-6D in patients with low-back pain or osteoarthritis knee pain (0.15 vs 0.05, respectively), suggesting a higher construct validity and responsiveness in these patients. Similar findings were observed by Van den Hout et al 49 in their study of patients undergoing lumbar discectomy.…”

Section: Discussionmentioning

confidence: 98%

“…In fact, few Brazilian studies have been published on health economics, 5,7,28,36,40 and none of them related to spine care in neurosurgery or orthopedics. Some countries have established that thresholds of what should be cost-effective: $50,000.00-$100,000.00 per QALY in the US, 41 Can$20,000.00-$40,000.00 in Canada, 23 and £20,000.00-£30,000.00 in the United Kingdom. 15 However, economic differences within each country prevent these values to be transposed to and used in Brazil.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Economic value of treating lumbar disc herniation in Brazil

Falavigna

Scheverin²,

Righesso

et al. 2016

SPI

View full text Add to dashboard Cite

OBJECT Lumbar discectomy is one of the most common surgical spine procedures. In order to understand the value of this surgical care, it is important to understand the costs to the health care system and patient for good results. The objective of this study was to evaluate for the first time the cost-effectiveness of spine surgery in Latin America for lumbar discectomy in terms of cost per quality-adjusted life year (QALY) gained for patients in Brazil. METHODS The authors performed a prospective cohort study involving 143 consecutive patients who underwent open discectomy for lumbar disc herniation (LDH). Patient-reported outcomes were assessed utilizing the SF-6D, which is derived from a 12-month variation of the SF-36. Direct medical costs included medical reimbursement, costs of hospital care, and overall resource consumption. Disability losses were considered indirect costs. A 4-year horizon with 3% discounting was applied to health-utilities estimates. Sensitivity analysis was performed by varying utility gain by 20%. The costs were expressed in Reais (R$) and US dollars ($), applying an exchange rate of 2.4:1 (the rate at the time of manuscript preparation). RESULTS The direct and indirect costs of open lumbar discectomy were estimated at an average of R$3426.72 ($1427.80) and R$2027.67 ($844.86), respectively. The mean total cost of treatment was estimated at R$5454.40 ($2272.66) (SD R$2709.17 [$1128.82]). The SF-6D utility gain was 0.044 (95% CI 0.03197–0.05923, p = 0.017) at 12 months. The 4-year discounted QALY gain was 0.176928. The estimated cost-utility ratio was R$30,828.35 ($12,845.14) per QALY gained. The sensitivity analysis showed a range of R$25,690.29 ($10,714.28) to R$38,535.44 ($16,056.43) per QALY gained. CONCLUSIONS The use of open lumbar discectomy to treat LDH is associated with a significant improvement in patient outcomes as measured by the SF-6D. Open lumbar discectomy performed in the Brazilian supplementary health care system provides a cost-utility ratio of R$30,828.35 ($12,845.14) per QALY. The value of acceptable cost-effectiveness will vary by country and region.

show abstract

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Economic value of treating lumbar disc herniation in Brazil

Falavigna

Scheverin²,

Righesso

et al. 2016

SPI

View full text Add to dashboard Cite

show abstract

“…Fehlings et al 3 calculated the financial costs and costeffectiveness of both ventral and dorsal fusion surgery for patients with CSM. Direct costs on average for both fu sion surgeries were $21,066 Canadian ($20,516 US).…”

Section: Studies Of Cost-effectivenessmentioning

confidence: 99%

“…In 2012, Fehlings et al 3 conducted a retrospec tive study of patients with CSM who were included in the AOSpine North America Cervical Spondylotic My elopathy Study (n = 70 cases; 45 patients in the ventral fusion cohort and 19 in the dorsal fusion cohort; 6 pa tients had both). The QOL outcomes measured by the mJOA (3point increase), NDI (11point decrease), SF36 (5point increase), and SF6D (0.07point increase) all showed significant (p < 0.0001) improvement by 1 year postoperatively.…”

Section: Studies Of Qol Outcomesmentioning

confidence: 99%

“…Recent studies have increasingly investigated financial cost and QOL outcomes for these 2 surgeries. 1,3,5,9,22 Despite the numerous studies on this topic, uncer tainty remains about which of the 2 procedures is optimal for the treatment of CSM. Previous reviews on the topic, including one in this journal, 13 have attempted to address this uncertainty by using physiological parameters and other preoperative factors that may aid in the selection of the optimal surgical approach.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Ventral fusion versus dorsal fusion: determining the optimal treatment for cervical spondylotic myelopathy

Alvin

Lubelski

Benzel

et al. 2013

FOC

View full text Add to dashboard Cite

Cervical spondylotic myelopathy (CSM) often can be surgically treated by either ventral or dorsal decompression and fusion. However, there is a lack of high-level evidence on the relative advantages and disadvantages for these treatments of CSM. The authors' goal was to provide a comprehensive review of the relative benefits of ventral versus dorsal fusion in terms of quality of life (QOL) outcomes, complications, and costs. They reviewed 7 studies on CSM published between 2003 and 2013 and summarized the findings for each category. Both procedures have been shown to lead to statistically significant improvement in clinical outcomes for patients. Ventral fusion surgery has been shown to yield better QOL outcomes than dorsal fusion surgery. Complication rates for ventral fusion surgery range from 11% to 13.6%, whereas those for dorsal fusion surgery range from 16.4% to 19%. Larger randomized controlled trials are needed, with particular emphasis on QOL and minimum clinically important differences.

show abstract

Ten‐year health‐related quality of life in cochlear implant recipients

et al. 2013

View full text Add to dashboard Cite

This study establishes the long-term sustained benefits of cochlear implantation on quality of life. Nevertheless, both the SF-36 and SF-6D seem to underestimate the benefit accrued through this intervention. Our data are consistent with others regarding the unsuitability of the SF-36 in benefit assessment, notwithstanding that conversion to the SF-6D is feasible, and the SF-6D seemed to better depict possible benefits from cochlear implantation as compared to the SF-36.

show abstract

Is surgery for cervical spondylotic myelopathy cost-effective? A cost-utility analysis based on data from the AOSpine North America prospective CSM study

Cited by 60 publications

References 35 publications

Economic value of treating lumbar disc herniation in Brazil

Economic value of treating lumbar disc herniation in Brazil

Ventral fusion versus dorsal fusion: determining the optimal treatment for cervical spondylotic myelopathy

Ten‐year health‐related quality of life in cochlear implant recipients

Contact Info

Product

Resources

About