Surgical Treatment of Spinal Stenosis with and without Degenerative Spondylolisthesis: Cost-Effectiveness after 2 Years

Tosteson, Anna N.A.; Lurie, Jon D.; Tosteson, Tor D.; Skinner, Jonathan; Herkowitz, Harry N.; Albert, Todd J.; Boden, Scott D.; Bridwell, Keith H.; Longley, Michael; Andersson, Gunnar; Blood, Emily A.; Grove, Margaret R.; Weinstein, James Neil

doi:10.7326/0003-4819-149-12-200812160-00003

Cited by 228 publications

(176 citation statements)

References 24 publications

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“…For DS, our failure rate was 9.2% over two years, somewhat higher than 6.8% from Burnett, but similar to 8.9% (35/394) reported from the SPORT study. 27,28 In addition, results from our PSA were similar to the base case analysis, showing higher cost and greater QALYs gained for the surgical strategies compared to the CC strategy ( Figure 6 & Figure 7). …”

Section: Discussionsupporting

confidence: 65%

“…28 This study remains the sole Level 1 evidence for the cost utility of surgical vs. medical management of LSS; however, it should be noted that the high degree of treatment cross-over after randomization likely introduced significant bias into the cost-utility analysis, artificially elevating the mean reported QALY gained in the medical cohort and falsely decreasing the incremental QALY gain and cost-effectiveness of lumbar laminectomy. [29][30][31] Both of these factors would have the effect of decreasing the observed cost-utility of surgical vs. medical management in this patient population.…”

Section: Discussionmentioning

confidence: 99%

“…18,27 Similarly, our DS QALY gained was 0.15, which compares to 0.08 from Skidmore and 0.16 from Burnett and 0.17 from Tosteson. 18,27,28 Finally, our analysis was limited to a two-year time horizon due to the available data. LSS is a lifetime condition, so longer time horizons may be of interest even in the commercial insurance market.…”

Section: Discussionmentioning

confidence: 99%

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Cost-effectiveness of three treatment strategies for lumbar spinal stenosis: Conservative care, laminectomy, and the Superion interspinous spacer

et al. 2015

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BackgroundLumbar spinal stenosis is a painful and debilitating condition resulting in healthcare costs totaling tens of billions of dollars annually. Initial treatment consists of conservative care modalities such as physical therapy, NSAIDs, opioids, and steroid injections. Patients refractory to these therapies can undergo decompressive surgery, which has good long-term efficacy but is more traumatic and can be associated with high post-operative adverse event (AE) rates. Interspinous spacers have been developed to offer a less-invasive alternative. The objective of this study was to compare the costs and quality adjusted life years (QALYs) gained of conservative care (CC) and decompressive surgery (DS) to a new minimally-invasive interspinous spacer.

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Section: Discussionsupporting

confidence: 65%

Section: Discussionmentioning

confidence: 99%

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Cost-effectiveness of three treatment strategies for lumbar spinal stenosis: Conservative care, laminectomy, and the Superion interspinous spacer

et al. 2015

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“…Cost analyses of numerous spinal surgical techniques for treating various pathologies permeate the spine literature, ranging from the management of degenerative disc disease to scoliosis deformity. [1][2][3]7,10,11,16,21,[24][25][26][27]30,31,38,39,43 Elucidating the elements that affect the cost of spinal surgery can have significant implications for providing safe care in a cost-effective manner. There is a paucity of studies that directly evaluate the cost of surgery for spinal tumors.…”

mentioning

confidence: 99%

Costs and readmission rates for the resection of primary and metastatic spinal tumors: a comparative analysis of 181 patients

Lau¹,

Chan²,

Theologis

et al. 2016

SPI

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OBJECTIVE Because the surgical strategies for primary and metastatic spinal tumors are different, the respective associated costs and morbidities associated with those treatments likely vary. This study compares the direct costs and 90-day readmission rates between the resection of extradural metastatic and primary spinal tumors. The factors associated with cost and readmission are identified. METHODS Adults (age 18 years or older) who underwent the resection of spinal tumors between 2008 and 2013 were included in the study. Patients with intradural tumors were excluded. The direct costs of index hospitalization and 90-day readmission hospitalization were evaluated. The direct costs were compared between patients who were treated surgically for primary and metastatic spinal tumors. The independent factors associated with costs and readmissions were identified using multivariate analysis. RESULTS A total of 181 patients with spinal tumors were included (63 primary and 118 metastatic tumors). Overall, the mean index hospital admission cost for the surgical management of spinal tumors was $52,083. There was no significant difference in the cost of hospitalization between primary ($55,801) and metastatic ($50,098) tumors (p = 0.426). The independent factors associated with higher cost were male sex (p = 0.032), preoperative inability to ambulate (p = 0.002), having more than 3 comorbidities (p = 0.037), undergoing corpectomy (p = 0.021), instrumentation greater than 7 levels (p < 0.001), combined anterior-posterior approach (p < 0.001), presence of a perioperative complication (p < 0.001), and longer hospital stay (p < 0.001). The perioperative complication rate was 21.0%. Of this cohort, 11.6% of patients were readmitted within 90 days, and the mean hospitalization cost of that readmission was $20,078. Readmission rates after surgical treatment for primary and metastatic tumors were similar (11.1% vs 11.9%, respectively) (p = 0.880). Prior hospital stay greater than 15 days (OR 6.62, p = 0.016) and diagnosis of lung metastasis (OR 52.99, p = 0.007) were independent predictors of readmission. CONCLUSIONS Primary and metastatic spinal tumors are comparable with regard to the direct costs of the index surgical hospitalization and readmission rate within 90 days. The factors independently associated with costs are related to preoperative health status, type and complexity of surgery, and postoperative course.

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“…Such unknown co-morbidity would tend to bias our results towards co-morbidity having no effect on utilisation of hospital based care. One of the major strengths of the current study is the long-term follow-up, as the majority of cost-effectiveness studies on spinal surgery in this patient population have not gone beyond 2 years of follow-up [8,21,26]. Kuntz et al [16] provided 10-year data, but this was done using a Markov-model, with input based on older data from different descriptive studies with varying follow-up time.…”

Section: Discussionmentioning

confidence: 99%

Long-term health care utilisation and costs after spinal fusion in elderly patients

2012

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Purpose Spinal fusion surgery rates in the elderly are increasing. Cost effectiveness analyses with relatively short-length follow-up have been performed. But the longterm effects in terms of health care use are largely unknown. The aim of the present study was to describe the long-term consequences of spinal fusion surgery in elderly patients on health care use and costs using a health care system perspective. Methods 194 patients undergoing spinal fusion between 2001 and 2005 (70 men, 124 women) with a mean age of 70 years (range 59-88) at surgery were included. Average length of follow-up was 6.2 years (range 0.3-9.0 years). Data on resource utilisation and costs were obtained from national registers providing complete coverage of all reimbursed contacts with primary-and secondary health care providers. Data were available from 3 years prior fusion surgery until the end of 2009. Results Use of hospital-based health care increased in the year prior to and the first year following surgery. Hereafter it normalised to the level of the background population and was mainly composed of diseases unrelated to the spine. In contrast, the use of primary health care appeared to increase immediately after surgery and continued to increase to a level that significantly exceeded that of the background population. It could be demonstrated that the increase was mainly due to an increasing number of general practitioner consultations. Conclusion Spinal fusion surgery in older patients does not generate excess hospital-based health care use in the longer term as compared with the background population, but primary care use increases.

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Surgical Treatment of Spinal Stenosis with and without Degenerative Spondylolisthesis: Cost-Effectiveness after 2 Years

Cited by 228 publications

References 24 publications

Cost-effectiveness of three treatment strategies for lumbar spinal stenosis: Conservative care, laminectomy, and the Superion interspinous spacer

Cost-effectiveness of three treatment strategies for lumbar spinal stenosis: Conservative care, laminectomy, and the Superion interspinous spacer

Costs and readmission rates for the resection of primary and metastatic spinal tumors: a comparative analysis of 181 patients

Long-term health care utilisation and costs after spinal fusion in elderly patients

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