Quality of life and cost-utility of surgical treatment for patients with spinal metastases: prospective cohort study

Abstract

Surgical treatment for spinal metastases is associated with significant improvement in health state value. In orthopaedic surgery, an ICUR less than $50,000/QALY gained is considered acceptable cost-effectiveness. Our results indicate that surgical treatment could be cost-effective.

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

“…Given the higher QALYs and lower costs in the present study, the ICER of €13,635 per QALY is significantly lower than the reported ICER of $42,003 per QALY in the Kobe study. 14 One of the limitations of the present study is the absence of prospectively collected health status data in the radiotherapy-only group. Therefore, their health status was modelled on that of the surgical group, based on the Patchell outcome data.² The latter method was also applied by Turner et al in the UK cost-utility study.…”

“…Sample sizes in the UK and Japanese studies were in the same order of magnitude. 12,14 One may wonder whether higher sample sizes would lead to less variation in both costs and QALYs, given the heterogeneity in clinical presentations, primary tumour types and individual outcomes. Thirdly, recent advances in the treatment of spinal metastases, such as stereotactic radiosurgery, were not included in the present analysis, since they were not available in our center.…”

“…13 Finally, Miyazaki et al found an ICER of US$42,003 per QALY in a prospective patient-level study in Kobe, Japan. 14 The huge variation in reporting costs is explained not only by differences in healthcare funding systems, but also by different methods of calculating costs. The societal perspective is best reflected in reimbursement from central funders to the hospitals, but to the hospital the direct costs are more relevant.…”

Surgery and Radiotherapy for Symptomatic Spinal Metastases Is More Cost Effective Than Radiotherapy Alone: A Cost Utility Analysis in a U.K. Spinal Center

“…6 This was considered to be more robust than comparison with a real world subject group with symptomatic spinal metastases who didn't undergo surgery, as their baseline characteristics are unlikely to match those of the surgery group. 9,22 It is expected that although the immediate hospital cost of surgically managing symptomatic spinal metastases is high, surgical intervention may mitigate community costs in the future by maintaining ambulation for a longer period, and as a result the community costs were modeled for both surgical and non-surgical groups using the methods outlined in the MSCC NICE economic analysis. 26 As both hospital reimbursement costs and community care costs were analyzed, this study had an NHS and social care perspective over a lifetime horizon.…”

“…18 In patients with symptomatic spinal metastases, 98 cost of surgical management over a lifetime horizon has been found to be both more expensive, 99 and more effective than non-surgical management 19,20 ; the incremental cost per QALY gained for surgery compared to radiotherapy alone has been estimated at $250,307 by Furlan et al (2012), 19 which is significantly higher than the $50,000 commonly used threshold in the US, 21 whilst Miyazaki et al (2017) estimated it at $42,003. 22 There is a paucity of data in this area, 23 and methodologies differ significantly, giving rise to significant variations in cost effectiveness.…”