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Cost per Quality Adjusted Life Year Gained of Revision Fusion for Lumbar Pseudoarthrosis: Defining the Value of Surgery.
MedLine Citation:
PMID:  24999554     Owner:  NLM     Status:  Publisher    
STUDY DESIGN: Single cohort study of patients undergoing revision fusion for lumbar pseudoarthrosis OBJECTIVE:: To assess the two-year comprehensive costs of revision arthrodesis for lumbar pseudoarthrosis at our institution and determine the associated cost per quality adjusted life year gained in this patient population SUMMARY OF BACKGROUND DATA:: The proportion of lumbar spine operations involving a fusion procedure has increased over the past two decades. Similarly, there has been a corresponding increase in the incidence and prevalence of pseudoarthrosis. However, the cost-effectiveness of revision surgery for pseudoarthrosis-associated back pain has yet to be examined.
METHODS:: Forty-seven patients undergoing revision instrumented arthrodesis for pseudoarthrosis associated back pain were included. Two-year total back-related medical resource utilization, missed work, and health-state values [quality adjusted life years (QALYs), calculated from EQ-5D with U.S. valuation] were assessed. Two-year resource use was multiplied by unit costs based on Medicare national allowable payment amounts (direct cost) and patient and care-giver work-day losses were multiplied by the self-reported gross-of-tax wage rate (indirect cost). Mean total two-year cost per QALY gained after revision surgery was assessed.
RESULTS:: Mean±SD duration of time between prior fusion and development of symptomatic pseudoarthrosis was 2.69±3.09 years. No patients developed symptomatic pseudoarthrosis by two-years after revision surgery. A mean cumulative two-year gain of 0.35 QALYs was reported. Mean±SD total two-year cost of revision fusion was $41,631±$9691 (surgery cost: $23,865±$270; outpatient resource utilization cost: $4,885±$2,301; indirect cost: $12,879±$8171). Revision instrumented arthrodesis was associated with a mean two-year cost per QALY gained of $118,945.
CONCLUSIONS:: Revision arthrodesis was associated with improved two-year quality of life in patients with pseudoarthrosis-related back pain. Nevertheless, in our experience revision surgery was shown to be marginally cost-effective at $118,945 per QALY gained.
Mph Owoicho Adogwa; Scott L Parker; David Shau; Stephen K Mendelhall; Oran Aaronson; Joseph Cheng; Clinton J Devin; Matthew J McGirt
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-7-3
Journal Detail:
Title:  Journal of spinal disorders & techniques     Volume:  -     ISSN:  1539-2465     ISO Abbreviation:  J Spinal Disord Tech     Publication Date:  2014 Jul 
Date Detail:
Created Date:  2014-7-7     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101140323     Medline TA:  J Spinal Disord Tech     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
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