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Cost-effectiveness of adult lumbar scoliosis surgery: an as-treated analysis from the adult symptomatic scoliosis surgery trial with 5-year follow-up

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Abstract

Study design

Longitudinal comparative cohort.

Objective

The purpose of this study is to report on the cost-effectiveness of surgical versus non-surgical treatment for Adult Symptomatic Lumbar Scoliosis (ASLS) using the as-treated data and provide a comparison to previously reported intent-to-treat (ITT) analysis.

Summary of background data

Adult spinal deformity is a relatively prevalent condition for which surgical treatment has become increasingly common but concerns surrounding complications, revision rates and cost-effectiveness remain unresolved. Of these issues, cost-effectiveness is perhaps the most difficult to quantify as the requisite data is difficult to obtain. The purpose of this study is to report on the cost-effectiveness of surgical versus non-surgical treatment for ASLS using the as-treated data and provide a comparison to previously reported ITT analysis.

Methods

Patients with at least 5-year follow-up data within the same treatment arm were included. Data collected every 3 months included use of nonoperative modalities, medications and employment status. Costs for surgeries and non-operative modalities were determined using Medicare Allowable rates. Medication costs were determined using the RedBook and indirect costs were calculated based on the reported employment status and income. Quality-Adjusted Life Years (QALY) was determined using the SF-6D.

Results

Of 226 patients, 195 patients (73 Non-op, 122 Op) met inclusion criteria. At 5 years, 29 (24%) patients in the Op group had a revision surgery of whom two had two revisions and one had three revisions. The cumulative cost for the Op group was $111,451 with a cumulative QALY gain of 2.3. The cumulative cost for the Non-Op group was $29,124 with a cumulative QALY gain of 0.4. This results in an ICER of $44,033 in favor of Op treatment.

Conclusion

This as-treated cost-effectiveness analysis demonstrates that surgical treatment for adult lumbar scoliosis becomes favorable at year-three, 1 year earlier than suggested by a previous intent-to-treat analysis.

Level of evidence

II.

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Funding

Funding was received from the National Institutes of Health, the Scoliosis Research Society and International Spine Study Group Foundation.

Author information

Authors and Affiliations

  1. Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY, 40202, USA

    Steven D. Glassman, Leah Y. Carreon & Charles H. Crawford III

  2. School of Medicine Department of Orthopaedic Surgery, University of Louisville, 550 S. Jackson St., 1st Floor ACB, Louisville, KY, 40202, USA

    Steven D. Glassman & Charles H. Crawford III

  3. Duke University Duke Spine Center-Clinic 1B/1C, 40 Duke Medicine Circle, Durham, NC, 27710-400, USA

    Christopher I. Shaffrey, Christine R. Baldus & Keith H. Bridwell

  4. Department of Orthopaedic Surgery, Washington University School of Medicine, 660 S. Euclid Ave, Campus Box 8233, St. Louis, MO, 63110, USA

    Michael P. Kelly & Elizabeth L. Yanik

  5. Departments of Medicine and Orthopaedics, Dartmouth-Hitchcock Medical Center, One Medical Center Dr., Lebanon, NH, 03756, USA

    Jon D. Lurie

  6. Department of Orthopaedic Surgery, Rocky Mountain Hospital for Children, 1721 E. 19th Ave., Suite 244, Denver, CO, 80218, USA

    R. Shay Bess

Authors
  1. Steven D. Glassman
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  2. Leah Y. Carreon
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  3. Christopher I. Shaffrey
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  4. Michael P. Kelly
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  8. R. Shay Bess
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  9. Christine R. Baldus
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  10. Keith H. Bridwell
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Contributions

Conception or design of the work: SDG, LYC and KHB. Acquisition of data: SDG, CIS, MPK, CHC, RSB, CRB and KHB. Analysis of data: SDG, LYC and ELY. Interpretation of data: SDG, LYC, ELY, JDL and KHB. Drafted the work: SDG, LYC. Revised it critically: SDG, LYC, CIS, MPK, CHC, ELY, JDL, RSB, CRB and KHB. Approved the version to be published: : SDG, LYC, CIS, MPK, CHC, ELY, JDL, RSB, CRB and KHB. Agree to be accountable for all aspects of the work: SDG, LYC, CIS, MPK, CHC, ELY, JDL, RSB, CRB and KHB.

Corresponding author

Correspondence to Leah Y. Carreon.

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Ethical standard

The manuscript submitted does not contain information about medical devices or drugs.

Human and animal right statement

This study was reviewed by the University of Louisville Institutional Review Board and was determined to be Not Human Subjects Research and Exempt from review.

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Glassman, S.D., Carreon, L.Y., Shaffrey, C.I. et al. Cost-effectiveness of adult lumbar scoliosis surgery: an as-treated analysis from the adult symptomatic scoliosis surgery trial with 5-year follow-up. Spine Deform 8, 1333–1339 (2020). https://doi.org/10.1007/s43390-020-00154-w

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