Cost-Effectiveness of Primary and Revision Surgery for Adult Spinal Deformity
Cost-Effectiveness of Primary and Revision Surgery for Adult Spinal Deformity
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DOI：
10.1097/brs.0000000000002481
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发表时间：
2018-06-01
期刊：
影响因子：
3
通讯作者：
Kebaish, Khaled M.
中科院分区：
文献类型：
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作者：
Raman, Tina;Nayar, Suresh K.;Kebaish, Khaled M.
研究设计。回溯性比较研究。这项研究的目的是比较成人脊柱畸形(ASD)患者接受初次手术或翻修手术后2年的功能结果、医院资源利用和脊柱相关成本。ASD手术后，患者可能需要翻修假性关节、植入物并发症或畸形进展。评估ASD初次手术，特别是翻修手术的成本-效果的数据很少。我们回顾了119名连续接受ASD初次或翻修手术的患者的记录。两年的脊柱相关总医疗费用是根据医院收费数据得出的。功能结果评分从前瞻性收集的患者数据中提取。计算和评估两年的成本效用比(成本/质量调整寿命年[QALY])，并以154,458美元/QALY的门槛进行评估(是2015年美国人均国内生产总值的三倍)。初次手术队列(n=56)和修订队列(n=63)在2年后显示健康相关生活质量评分显著改善。手术和脊柱相关2年随访费用的中位数，初次手术为137,990美元(四分位数范围[IQR]，84,186美元)，翻修手术为115,509美元(IQR，63,753美元)，两组之间没有显著差异(P=0.12)。我们报告了两年的QALY增长，初次手术组为0.36，翻修组为0.40(P=0.71)。初次内固定融合与翻修手术每QALY的中位数2年成本分别为197,809美元(IQR，187,350美元)和129,950美元(IQR，209,928美元)相关(P=0.31)。与初次手术相比，ASD翻修手术的两年总成本更低，QALY收益更高，尽管差异不显著。尽管ASD的翻修手术在技术上具有挑战性，并且与初次手术相比，主要并发症的发生率更高，但翻修手术在2年时是具有成本效益的。ASD初次手术的费用/QALY比率在2年内超过了成本效益的阈值。
Study Design. Retrospective comparative study.Objective. The purpose of this study is to compare functional outcomes, hospital resource utilization, and spine-related costs during 2 years in patients who had undergone primary or revision surgery for adult spinal deformity (ASD).Summary of Background Data. After surgery for ASD, patients may require revision for pseudarthrosis, implant complications, or deformity progression. Data evaluating cost-effectiveness of primary and, in particular, revision surgery, for ASD are sparse.Methods. We retrospectively reviewed records for 119 consecutive patients who had undergone primary or revision surgery for ASD. Two-year total spine-related medical costs were derived from hospital charge data. Functional outcome scores were extracted from prospectively collected patient data. Cost utility ratios (cost/quality-adjusted life-year [QALY]) at 2 years were calculated and assessed against a threshold of $154,458/QALY gained (three times the 2015 US per-capita gross domestic product).Results. The primary surgery cohort (n = 56) and revision cohort (n = 63) showed significant improvements in healthrelated quality-of-life scores at 2 years. Median surgical and spine-related 2-year follow-up costs were $ 137,990 (interquartile range [IQR], $84,186) for primary surgery and $ 115,509 (IQR, $ 63,753) for revision surgery and were not significantly different between the two groups (P = 0.12). We report 2-year QALY gains of 0.36 in the primary surgery cohort and 0.40 in the revision group (P = 0.71). Primary instrumented fusion was associated with a median 2-year cost per QALY of $ 197,809 (IQR, $187,350) versus $129,950 (IQR, $ 209,928) for revision surgery (P = 0.31).Conclusion. Revision surgery had lower total 2-year costs and higher QALY gains than primary surgery for ASD, although the differences were not significant. Although revision surgery for ASD is known to be technically challenging and to have a higher rate of major complications than primary surgery, revision surgery was cost-effective at 2 years. The cost/QALY ratio for primary surgery for ASD exceeded the threshold for cost effectiveness at 2 years.