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Factors Associated With the Maintenance of Cost-effectiveness at Five Years in Adult Spinal Deformity Corrective Surgery.

Publication ,  Journal Article
Passias, PG; Mir, JM; Dave, P; Smith, JS; Lafage, R; Gum, J; Line, BG; Diebo, B; Daniels, AH; Hamilton, DK; Buell, TJ; Scheer, JK; Mullin, JP ...
Published in: Spine (Phila Pa 1976)
October 15, 2024

STUDY DESIGN: Retrospective cohort. OBJECTIVE: To evaluate factors associated with the long-term durability of cost-effectiveness (CE) in ASD patients. BACKGROUND: A substantial increase in costs associated with the surgical treatment for adult spinal deformity (ASD) has given precedence to scrutinize the value and utility it provides. METHODS: We included 327 operative ASD patients with five-year (5 yr) follow-up. Published methods were used to determine costs based on CMS.gov definitions and were based on the average DRG reimbursement rates. The utility was calculated using quality-adjusted life-years (QALY) utilizing the Oswestry Disability Index (ODI) converted to Short-Form Six-Dimension (SF-6D), with a 3% discount applied for its decline in life expectancy. The CE threshold of $150,000 was used for primary analysis. RESULTS: Major and minor complication rates were 11% and 47%, respectively, with 26% undergoing reoperation by five years. The mean cost associated with surgery was $91,095±$47,003, with a utility gain of 0.091±0.086 at one years, QALY gained at 2 years of 0.171±0.183, and at five years of 0.42±0.43. The cost per QALY at two years was $414,885, which decreased to $142,058 at five years.With the threshold of $150,000 for CE, 19% met CE at two years and 56% at five years. In those in which revision was avoided, 87% met cumulative CE till life expectancy. Controlling analysis depicted higher baseline CCI and pelvic tilt (PT) to be the strongest predictors for not maintaining durable CE to five years [CCI OR: 1.821 (1.159-2.862), P =0.009] [PT OR: 1.079 (1.007-1.155), P =0.030]. CONCLUSIONS: Most patients achieved cost-effectiveness after four years postoperatively, with 56% meeting at five years postoperatively. When revision was avoided, 87% of patients met cumulative cost-effectiveness till life expectancy. Mechanical complications were predictive of failure to achieve cost-effectiveness at two years, while comorbidity burden and medical complications were at five years.

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Published In

Spine (Phila Pa 1976)

DOI

EISSN

1528-1159

Publication Date

October 15, 2024

Volume

49

Issue

20

Start / End Page

1401 / 1409

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Spinal Curvatures
  • Retrospective Studies
  • Reoperation
  • Quality-Adjusted Life Years
  • Postoperative Complications
  • Orthopedics
  • Middle Aged
  • Male
  • Humans
 

Citation

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Passias, P. G., Mir, J. M., Dave, P., Smith, J. S., Lafage, R., Gum, J., … International Spine Study Group. (2024). Factors Associated With the Maintenance of Cost-effectiveness at Five Years in Adult Spinal Deformity Corrective Surgery. Spine (Phila Pa 1976), 49(20), 1401–1409. https://doi.org/10.1097/BRS.0000000000004982
Passias, Peter G., Jamshaid M. Mir, Pooja Dave, Justin S. Smith, Renaud Lafage, Jeffrey Gum, Breton G. Line, et al. “Factors Associated With the Maintenance of Cost-effectiveness at Five Years in Adult Spinal Deformity Corrective Surgery.Spine (Phila Pa 1976) 49, no. 20 (October 15, 2024): 1401–9. https://doi.org/10.1097/BRS.0000000000004982.
Passias PG, Mir JM, Dave P, Smith JS, Lafage R, Gum J, et al. Factors Associated With the Maintenance of Cost-effectiveness at Five Years in Adult Spinal Deformity Corrective Surgery. Spine (Phila Pa 1976). 2024 Oct 15;49(20):1401–9.
Passias, Peter G., et al. “Factors Associated With the Maintenance of Cost-effectiveness at Five Years in Adult Spinal Deformity Corrective Surgery.Spine (Phila Pa 1976), vol. 49, no. 20, Oct. 2024, pp. 1401–09. Pubmed, doi:10.1097/BRS.0000000000004982.
Passias PG, Mir JM, Dave P, Smith JS, Lafage R, Gum J, Line BG, Diebo B, Daniels AH, Hamilton DK, Buell TJ, Scheer JK, Eastlack RK, Mullin JP, Mundis GM, Hosogane N, Yagi M, Schoenfeld AJ, Uribe JS, Anand N, Mummaneni PV, Chou D, Klineberg EO, Kebaish KM, Lewis SJ, Gupta MC, Kim HJ, Hart RA, Lenke LG, Ames CP, Shaffrey CI, Schwab FJ, Lafage V, Hostin RA, Bess S, Burton DC, International Spine Study Group. Factors Associated With the Maintenance of Cost-effectiveness at Five Years in Adult Spinal Deformity Corrective Surgery. Spine (Phila Pa 1976). 2024 Oct 15;49(20):1401–1409.

Published In

Spine (Phila Pa 1976)

DOI

EISSN

1528-1159

Publication Date

October 15, 2024

Volume

49

Issue

20

Start / End Page

1401 / 1409

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Spinal Curvatures
  • Retrospective Studies
  • Reoperation
  • Quality-Adjusted Life Years
  • Postoperative Complications
  • Orthopedics
  • Middle Aged
  • Male
  • Humans