SPINESCAN LITERATURE REVIEW
Issue 1, Volume 1
Implications of the SPORT Study
Recent Research on Operative and Non-operative Spine Care

Comparative Effectiveness Evidence From the Spine Patient Outcomes Research Trial

Spine. 2011;36(24):2061-68

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.

Next Article:
Evidence-Based Recommendations for Spine Surgery
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