Comparative Effectiveness Evidence From the Spine Patient Outcomes Research Trial
Introduction: Using Spine Patient Outcomes Research Trial data, this study aimed to analyze the cost-effectives of surgery versus nonoperative care for 3 common diagnoses: spinal stenosis (SPS), degenerative spondylolisthesis (DS), and intervertebral disc herniation (IDH).
Methods: Patients included in the study had confirmed diagnoses of SPS, DS, or IDH, and they were followed in randomized or observational cohorts. Resource use, productivity, and EuroQol EQ-5D health state values were measured at 6 week, 3, 6, 12, 24, 36, and 48 months.
Researchers estimated (in 2004 US dollars) cost per quality-adjusted life year (QALY) gained for surgery compared to nonoperative care; this was done using a societal perspective, and costs and QALYs were discounted at 3% per year.
Results: In the SPS patients, surgery was initially performed or during the 4-year follow-up period in 415 out of 635 patients (65.3%). For DS patients, 391 out of 601 (65.1%) initially had surgery or during the follow-up period; in IDH patients, it was 789 out of 1192 (66.2%).
This analysis showed that surgery improved health. There were persistent QALY differences throughout the 4-year follow-up period.
SPS QALY gain: 0.22 (95% confidence interval [CI] 0.15, 0.34)
DS QALY gain: 0.34 (95% CI 0.30, 0.47)
IDH QALY gain: 0.34 (95% CI 0.31, 0.38)
Also important to note is the cost per QALY gained.
SPS cost per QALY gained: decreased from $77,600 at 2 years to $59,400 at 4 years (95% CI $37,059, $125,162)
DS cost per QALY gained: decreased from $115,600 at 2 years to $64,300 at 4 years (95% CI $32,864, $83,117)
IDH cost per QALY gained: $34,355 at 2 years to $20,600 at 4 years (95% CI $4,539, $33,088)
Conclusion: In patients with a clear diagnosis of spinal stenosis, degenerative spondylolisthesis, or intervertebral disc herniation, surgery was a good value when compared with nonoperative care over 4 years.
Commentary
The benefit of surgical treatment for compressive lesions has been demonstrated by the follow-up SPORT studies. This cost-benefit analysis further validates surgery as a treatment option for decompressive procedures, especially lumbar stenosis and disc herniation. Surgical treatment of degenerative spondylolisthesis also did, but to a lesser degree because of hardware expenses.
