A Cost-Utility Analysis of Lumbar Decompression With and Without Fusion for Degenerative Spine Disease in the Elderly. (October 2015)

• Record Type: Journal Article
• Authors: Devin, Clinton J.; Chotai, Silky; Parker, Scott L.; Tetreault, Lindsay; Fehlings, Michael G.; McGirt, Matthew J.
• Other Names: Fehlings Michael G. section editor.; Mroz Thomas section editor.; Choma Theodore J. section editor.; Harrop James S. section editor.
• Is Part Of: Neurosurgery. Volume 77:(2015)Supplement 1
• Publication Date: 2015-10
• Subjects: Cost -- Cost-effectiveness -- Cost utility -- Decompression -- Elderly -- Fusion -- Lumbar -- QALY; Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1227/NEU.0000000000000949
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract : BACKGROUND: Value-based purchasing is rapidly being implemented to rein in the unsustainably rising costs of the US healthcare system. With a growing elderly population, it is vital to understand the value of spinal surgery in this group of individuals. OBJECTIVE: To compare the cost-effectiveness of lumbar decompression with and without fusion for degenerative spine disease in elderly vs nonelderly patients. METHODS: A total of 221 patients undergoing elective primary surgery for degenerative lumbar pathology who were enrolled in a prospective longitudinal registry were analyzed. Patient-reported outcomes of Oswestry Disability Index, numeric rating scale for back and leg pain, and quality-of-life scores (EuroQol-5D) were recorded. Two-year back-related medical resource use, missed work, and health-state values (quality-adjusted life-years [QALYs]) were assessed. Two-year resource use was multiplied by unit costs based on Medicare national allowable payment amounts (direct cost). Patient and caregiver workday losses were multiplied by gross-of-tax wage rate (indirect cost). Patients were divided into age groups <70 and ≥70 years. RESULTS: Mean cumulative 2-year QALYs gained were statistically similar between younger and older patients for both decompression alone (0.67 ± 0.65 vs 0.56 ± 0.65; P = .47) and decompression with fusion (0.56 ± 0.55 vs 0.59 ± 0.55; P = .26). Mean 2-year cost per QALY gained between younger and older patients was similar for both decompression alone ($24 365 vs $31 750 per QALY; P = .11) and decompression with fusion ($64 228 vs $60 183 per QALY; P = .09). CONCLUSION: Surgical treatment provided significant improvements in pain, disability, and quality of life for elderly patients with degenerative lumbar disease. Observed costs per QALY gained for lumbar decompression with and without fusion were similar for younger and older patients, demonstrating that lumbar spine surgery in the elderly is an equally cost-effective and valuable intervention. ABBREVIATIONS: EQ-5D, EuroQol-5D MCID, minimal clinically important difference ODI, Oswestry Disability Index PRO, patient-reported outcome QALY, quality-adjusted life-year SF-6D, Short Form-6 dimension SF-12, Short Form 12-item health surgery SPORT, Spinal Patient Outcomes Research Trial