| Comparative effectiveness evidence from the spine patient outcomes research trial: surgical versus nonoperative care for spinal stenosis, degenerative spondylolisthesis, and intervertebral disc herniation. | |
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MedLine Citation:
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PMID: 22048651 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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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:
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Type: Comparative Study; Journal Article; Research Support, N.I.H., Extramural; Research Support, U.S. Gov't, P.H.S. |
Journal Detail:
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Title: Spine Volume: 36 ISSN: 1528-1159 ISO Abbreviation: Spine Publication Date: 2011 Nov |
Date Detail:
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Created Date: 2011-11-03 Completed Date: 2012-03-16 Revised Date: 2013-03-13 |
Medline Journal Info:
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Nlm Unique ID: 7610646 Medline TA: Spine (Phila Pa 1976) Country: United States |
Other Details:
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Languages: eng Pagination: 2061-8 Citation Subset: IM |
Affiliation:
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The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Medical School, Lebanon, NH 03756, USA. anna.tosteson@dartmouth.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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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:
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P60-AR048094/AR/NIAMS NIH HHS; U01 AR045444-14/AR/NIAMS NIH HHS; U01-AR45444/AR/NIAMS NIH HHS |
| Comments/Corrections | |
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