Document Detail


Comparative effectiveness evidence from the spine patient outcomes research trial: surgical versus nonoperative care for spinal stenosis, degenerative spondylolisthesis, and intervertebral disc herniation.
MedLine Citation:
PMID:  22048651     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
STUDY DESIGN: Cost-effectiveness analysis of a randomized plus observational cohort trial.
OBJECTIVE: Analyze cost-effectiveness of Spine Patient Outcomes Research Trial data over 4 years comparing surgery with nonoperative care for three common diagnoses: spinal stenosis (SPS), degenerative spondylolisthesis (DS), and intervertebral disc herniation (IDH).
SUMMARY OF BACKGROUND DATA: Spine surgery rates continue to rise in the United States, but the safety and economic value of these procedures remain uncertain.
METHODS: Patients with image-confirmed diagnoses were followed in randomized or observational cohorts with data on resource use, productivity, and EuroQol EQ-5D health state values measured at 6 weeks, 3, 6, 12, 24, 36, and 48 months. For each diagnosis, cost per quality-adjusted life year (QALY) gained in 2004 US dollars was estimated for surgery relative to nonoperative care using a societal perspective, with costs and QALYs discounted at 3% per year.
RESULTS: Surgery was performed initially or during the 4-year follow-up among 414 of 634 (65.3%) SPS, 391 of 601 (65.1%) DS, and 789 of 1192 (66.2%) IDH patients. Surgery improved health, with persistent QALY differences observed through 4 years (SPS QALY gain 0.22; 95% confidence interval, CI: 0.15, 0.34; DS QALY gain 0.34, 95% CI: 0.30, 0.47; and IDH QALY gain 0.34, 95% CI: 0.31, 0.38). Costs per QALY gained decreased for SPS from $77,600 at 2 years to $59,400 (95% CI: $37,059, $125,162) at 4 years, for DS from $115,600 to $64,300 per QALY (95% CI: $32,864, $83,117), and for IDH from $34,355 to $20,600 per QALY (95% CI: $4,539, $33,088).
CONCLUSION: Comparative effectiveness evidence for clearly defined diagnostic groups from Spine Patient Outcomes Research Trial shows good value for surgery compared with nonoperative care over 4 years.
Authors:
Anna N A Tosteson; Tor D Tosteson; Jon D Lurie; William Abdu; Harry Herkowitz; Gunnar Andersson; Todd Albert; Keith Bridwell; Wenyan Zhao; Margaret R Grove; Milton C Weinstein; James N Weinstein
Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Spine     Volume:  36     ISSN:  1528-1159     ISO Abbreviation:  Spine     Publication Date:  2011 Nov 
Date Detail:
Created Date:  2011-11-03     Completed Date:  2012-03-16     Revised Date:  2013-08-21    
Medline Journal Info:
Nlm Unique ID:  7610646     Medline TA:  Spine (Phila Pa 1976)     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2061-8     Citation Subset:  IM    
Affiliation:
The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Medical School, Lebanon, NH 03756, USA. anna.tosteson@dartmouth.edu
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MeSH Terms
Descriptor/Qualifier:
Comparative Effectiveness Research
Cost-Benefit Analysis
Humans
Intervertebral Disc Displacement / economics,  surgery*,  therapy
Orthopedic Procedures / economics,  methods,  statistics & numerical data
Outcome Assessment (Health Care) / economics,  methods,  statistics & numerical data
Quality-Adjusted Life Years*
Questionnaires
Randomized Controlled Trials as Topic / economics
Spinal Stenosis / economics,  surgery*,  therapy
Spondylolisthesis / economics,  surgery*,  therapy
Grant Support
ID/Acronym/Agency:
P60 AR048094/AR/NIAMS NIH HHS; P60-AR048094/AR/NIAMS NIH HHS; U01 AR045444/AR/NIAMS NIH HHS; U01 AR045444-14/AR/NIAMS NIH HHS; U01-AR45444/AR/NIAMS NIH HHS
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