Patient-reported Outcomes Following Surgical Intervention for Adolescent Idiopathic Scoliosis

Aghdasi, Bayan; Bachmann, Keith R.; Clark, Damian; Koldenhoven, Rachel M.; Sultan, Mark R.; George, Jose; Singla, Anuj; Abel, Mark F.

doi:10.1097/bsd.0000000000000822

Cited by 26 publications

(36 citation statements)

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“…No death state was included in the model given that patients were young, and the procedures are not associated with a significant risk of death. 43,51 Also, there is unlikely to be a difference in mortality between the procedures. 52 Diagrams of the model structure for patients in the VBT and spinal fusion treatment groups are provided in Figure 2.…”

Section: Model Structurementioning

confidence: 99%

“…Data from NCT02897453 were used to derive the mean postoperative VBT utility, and data from Aghdasi et al to derive the mean postoperative spinal fusion and preoperative utilities. 39,43 This was a large meta-analysis that reported preference-based outcomes for 1494 pediatric and young adult patients that underwent spinal fusion for the treatment of IS, with a mean age of 14.6 years. 43 Cobb angle and Sanders stage was not reported for this population.…”

Section: Heath State Utility Weightingmentioning

confidence: 99%

“…39,43 This was a large meta-analysis that reported preference-based outcomes for 1494 pediatric and young adult patients that underwent spinal fusion for the treatment of IS, with a mean age of 14.6 years. 43 Cobb angle and Sanders stage was not reported for this population. Scoliosis Research Society Outcomes Questionnaire (SRS-22r) scores were reported for both the NCT02897453 and Aghdasi et al cohorts.…”

Section: Heath State Utility Weightingmentioning

confidence: 99%

“…Scoliosis Research Society Outcomes Questionnaire (SRS-22r) scores were reported for both the NCT02897453 and Aghdasi et al cohorts. 39,43 For VBT, scores from the NCT02897453 cohort were reported over a range of time points, from 27-89 months after index surgery. 39 For spinal fusion, Aghdasi et al reported three sets of mean scores from Quarterly probability of VBT revision 0.77% a (equivalent to a cumulative 2-year revision probability of 6.02%)…”

Section: Heath State Utility Weightingmentioning

confidence: 99%

“…34,39 While costs associated with spinal fusion as a treatment for pediatric patients with IS have been reported in the literature, few cost-effectiveness analyses investigating spinal fusion in IS have been performed. [40][41][42][43] Additionally, to the best of our knowledge, there are no previous costing or cost-effectiveness analyses investigating VBT for the treatment of IS. VBT is associated with higher device costs compared with spinal fusion.…”

mentioning

confidence: 99%

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Cost-Utility Analysis of Anterior Vertebral Body Tethering versus Spinal Fusion in Idiopathic Scoliosis from a US Integrated Healthcare Delivery System Perspective

Polly¹,

Larson²,

Samdani³

et al. 2021

CEOR

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Anterior vertebral body tethering (VBT) is a non-fusion, minimally invasive, growth-modulating procedure with some early positive clinical outcomes reported in pediatric patients with idiopathic scoliosis (IS). VBT offers potential health-related quality of life (HRQoL) benefits over spinal fusion in allowing patients to retain a greater range of motion after surgery. We conducted an early cost-utility analysis (CUA) to compare VBT with fusion as a first-choice surgical treatment for skeletally immature patients (age >10 years) with moderate to severe IS, who have failed nonoperative management, from a US integrated healthcare delivery system perspective. Patients and Methods: The CUA uses a Markov state transition model, capturing a 15year period following index surgery. Transition probabilities, including revision risk and subsequent fusion, were based on published surgical outcomes and an ongoing VBT observational study (NCT02897453). Patients were assigned utilities derived from published patient-reported outcomes (PROs; SRS-22r mapped to EQ-5D) following fusion and the above VBT study. Index and revision procedure costs were included. Probabilistic (PSA) and deterministic sensitivity analyses (DSA) were performed. Results: VBT was associated with higher costs but also higher quality-adjusted life years (QALYs) than fusion (incremental costs: $45,546; QALYs gained: 0.54). The subsequent incremental cost-effectiveness ratio for VBT vs fusion was $84,391/QALY gained. Mean PSA results were similar to the base case, indicating that results were generally robust to uncertainty. The DSA indicated that results were most sensitive to variations in utility values. Conclusion: This is the first CUA comparing VBT with fusion in pediatric patients with IS and suggests that VBT may be a cost-effective alternative to fusion in the US, given recommended willingness-to-pay thresholds ($100,000-$150,000). The results rely on HRQoL benefits for VBT compared with fusion. For improved model accuracy, further analyses with longer-term PROs for VBT, and comparative effectiveness studies, would be needed.

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Section: Model Structurementioning

confidence: 99%

Section: Heath State Utility Weightingmentioning

confidence: 99%