Surgery and Radiotherapy for Symptomatic Spinal Metastases Is More Cost Effective Than Radiotherapy Alone: A Cost Utility Analysis in a U.K. Spinal Center
Abstract:Our results demonstrate that reimbursement to hospitals for surgical management of symptomatic spinal metastases in the United Kingdom is broadly in line with costs, and that there was an overall saving as a result of community care costs being mitigated by patients walking for longer, which is within the expected National Health Service threshold. Surgery for metastatic spinal tumors is effective and a good value for the money.
“…Quality adjusted life years (QALYs) for surgical patients were generated by calculating the area under the curve when directly connecting health utility scores over time, including discounting at 3.5% a year, as described previously. 12,18 QALY calculation for the non-surgical group was modelled on the surgical group. Survival was reduced to 79% based on the study by Patchell et al 2 Health utility was modelled as staying at the pre-operative level, as it is assumed immediate improvement in status is related to surgery, then declining linearly until point of death once the matched surgical patient's health status started to decline.…”
Section: Outcome Measuresmentioning
confidence: 99%
“…Two sensitivity analyses representing an initial over-and underestimation of QALYs were completed to make the analysis more robust, as described previously. 12…”
Section: Outcome Measuresmentioning
confidence: 99%
“…Ideally, both match as far as possible, but in practice these costs may diverge. 12 Furthermore, in assessing costs, patient-level data are more reliable and robust than calculations based on national averages, given the varied presentation, disease load, response to systemic treatment and outcome in this patient group. This explains the variability in costs for surgery and/or radiotherapy, with a standard deviation equalling 48% of the average cost and an IQR stretching over almost 50% of the median cost.…”
Section: Accepted Manuscriptmentioning
confidence: 99%
“…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. 12 However, in addition to the UK study, the non-surgical patients in the present analysis were not a modelled cohort, but real patients with real patient-level costs.…”
Section: Accepted Manuscriptmentioning
confidence: 99%
“…Turner et al found that over a lifetime horizon the mean incremental cost was £12,839 cheaper for the surgical group, but with a large standard deviation of £37,896 and a median incremental cost difference that was slightly more expensive for the surgical group. 12 hospital cost data. 13 Finally, Miyazaki et al found an ICER of US$42,003 per QALY in a prospective patient-level study in Kobe, Japan.…”
Cost-utility analysis of surgery and radiotherapy for symptomatic spinal utility analysis of surgery and radiotherapy for symptomatic spinal utility analysis of surgery and radiotherapy for symptomatic spinal utility analysis of surgery and radiotherapy for symptomatic spinal metastases in a Belgian specialist center. metastases in a Belgian specialist center. metastases in a Belgian specialist center. metastases in a Belgian specialist center.
“…Quality adjusted life years (QALYs) for surgical patients were generated by calculating the area under the curve when directly connecting health utility scores over time, including discounting at 3.5% a year, as described previously. 12,18 QALY calculation for the non-surgical group was modelled on the surgical group. Survival was reduced to 79% based on the study by Patchell et al 2 Health utility was modelled as staying at the pre-operative level, as it is assumed immediate improvement in status is related to surgery, then declining linearly until point of death once the matched surgical patient's health status started to decline.…”
Section: Outcome Measuresmentioning
confidence: 99%
“…Two sensitivity analyses representing an initial over-and underestimation of QALYs were completed to make the analysis more robust, as described previously. 12…”
Section: Outcome Measuresmentioning
confidence: 99%
“…Ideally, both match as far as possible, but in practice these costs may diverge. 12 Furthermore, in assessing costs, patient-level data are more reliable and robust than calculations based on national averages, given the varied presentation, disease load, response to systemic treatment and outcome in this patient group. This explains the variability in costs for surgery and/or radiotherapy, with a standard deviation equalling 48% of the average cost and an IQR stretching over almost 50% of the median cost.…”
Section: Accepted Manuscriptmentioning
confidence: 99%
“…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. 12 However, in addition to the UK study, the non-surgical patients in the present analysis were not a modelled cohort, but real patients with real patient-level costs.…”
Section: Accepted Manuscriptmentioning
confidence: 99%
“…Turner et al found that over a lifetime horizon the mean incremental cost was £12,839 cheaper for the surgical group, but with a large standard deviation of £37,896 and a median incremental cost difference that was slightly more expensive for the surgical group. 12 hospital cost data. 13 Finally, Miyazaki et al found an ICER of US$42,003 per QALY in a prospective patient-level study in Kobe, Japan.…”
Cost-utility analysis of surgery and radiotherapy for symptomatic spinal utility analysis of surgery and radiotherapy for symptomatic spinal utility analysis of surgery and radiotherapy for symptomatic spinal utility analysis of surgery and radiotherapy for symptomatic spinal metastases in a Belgian specialist center. metastases in a Belgian specialist center. metastases in a Belgian specialist center. metastases in a Belgian specialist center.
BackgroundBoth nonoperative and operative treatments for spinal metastasis are expensive interventions. Patients' expected 3‐month survival is believed to be a key factor to determine the most suitable treatment. However, to the best of our knowledge, no previous study lends support to the hypothesis. We sought to determine the cost‐effectiveness of operative and nonoperative interventions, stratified by patients' predicted probability of 3‐month survival.MethodsA Markov model with four defined health states was used to estimate the quality‐adjusted life years (QALYs) and costs for operative intervention with postoperative radiotherapy and radiotherapy alone (palliative low‐dose external beam radiotherapy) of spine metastases. Transition probabilities for the model, including the risks of mortality and functional deterioration, were obtained from secondary and our institutional data. Willingness to pay thresholds were prespecified at $100,000 and $150,000. The analyses were censored after 5‐year simulation from a health system perspective and discounted outcomes at 3% per year. Sensitivity analyses were conducted to test the robustness of the study design.ResultsThe incremental cost‐effectiveness ratios were $140,907 per QALY for patients with a 3‐month survival probability >50%, $3,178,510 per QALY for patients with a 3‐month survival probability <50%, and $168,385 per QALY for patients with independent ambulatory and 3‐month survival probability >50%.ConclusionsThis study emphasizes the need to choose patients carefully and estimate preoperative survival for those with spinal metastases. In addition to reaffirming previous research regarding the influence of ambulatory status on cost‐effectiveness, our study goes a step further by highlighting that operative intervention with postoperative radiotherapy could be more cost‐effective than radiotherapy alone for patients with a better survival outlook. Accurate survival prediction tools and larger future studies could offer more detailed insights for clinical decisions.
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