Cost-effectiveness Improves for Operative vs Nonoperative Treatment of Adult Symptomatic Lumbar Scoliosis at Eight-Year Follow-up

Leah Y Carreon; Steven D Glassman; Justin S Smith; Michael P Kelly; Elizabeth L Yanik; Christine R Baldus; Jon D Lurie; Charles Edwards; Lawrence G Lenke; Jacob M Buchowski; Charles H Crawford 3rd; Tyler Koski; Virginie Lafage; Munish Gupta; Han Jo Kim; Christopher P Ames; Shay Bess; Frank J Schwab; Christopher I Shaffrey; Keith H Bridwell

doi:10.1097/BRS.0000000000005186

Cost-effectiveness Improves for Operative vs Nonoperative Treatment of Adult Symptomatic Lumbar Scoliosis at Eight-Year Follow-up

Spine (Phila Pa 1976). 2024 Oct 14. doi: 10.1097/BRS.0000000000005186. Online ahead of print.

Authors

Leah Y Carreon¹, Steven D Glassman¹, Justin S Smith², Michael P Kelly³, Elizabeth L Yanik⁴, Christine R Baldus⁴, Jon D Lurie⁵, Charles Edwards⁶, Lawrence G Lenke⁷, Jacob M Buchowski³, Charles H Crawford 3rd¹, Tyler Koski⁸, Virginie Lafage⁹, Munish Gupta⁴, Han Jo Kim¹⁰, Christopher P Ames¹¹, Shay Bess¹², Frank J Schwab⁹, Christopher I Shaffrey⁶, Keith H Bridwell⁴

Affiliations

¹ Norton Leatherman Spine Center, 210 East Gray Street, Ste 900, Louisville, KY, 40202, USA.
² Department of Neurosurgery, University of Virginia, PO Box 800212, Charlottesville, VA, 22908, USA.
³ Department of Orthopedic Surgery, Rady Children's Hospital, 3020 Children's Way, San Diego, CA, 92123, USA.
⁴ Department of Orthopedic Surgery, Washington University School of Medicine, Campus Box 8233, 600 South Euclid Ave, Box 8233, St Louis, MO, 63110, USA.
⁵ Department of Medicine, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, 03781, USA.
⁶ Mercy Medical Center, 345 St. Paul Place, Baltimore, MD, 21202, USA.
⁷ Department of Orthopedic Surgery, Columbia University, Och Spine Hospital at New York-Presbyterian/Allen, 5141 Broadway, New York, NY, USA.
⁸ Department of Neurological Surgery, Northwestern University, Lavin Family Pavilion, 259 E Erie St Ste 13-205, Chicago, IL, 60611, USA.
⁹ Department of Orthopedic Surgery, Lenox Hill Hospital, 100 E 77th St, New York, NY, 10075, USA.
¹⁰ Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
¹¹ Department of Neurosurgery, University of California San Francisco, 505 Parnassus Avenue, RM M-779, Box 0112, San Francisco, CA, USA.
¹² Denver International Spine Center, Presbyterian St. Luke's/Rocky Mountain Hospital for Children, 1601 E 19th Ave Ste 6250, Denver, CO, USA.

PMID: 39397347
DOI: 10.1097/BRS.0000000000005186

Abstract

Study design: Secondary data analysis of the NIH sponsored study on Adult Symptomatic Lumbar Scoliosis (ASLS).

Objectives: The purpose of this study is to perform a cost-effectiveness analysis comparing operative versus non-operative care for ASLS eight years after enrollment.

Summary of background data: A prior cost-effectiveness analysis of the current cohort comparing operative to non-operative care at five years after enrollment showed and ICER of $44,033 in the As-Treated analysis and a ICER of $27,480 in the Intent-to-treat analysis.

Methods: Data was collected every three months for the first two years, then every six months for the remainder of the study. Data included use of non-operative modalities, medications and employment status. Costs for index and revision surgeries and non-operative modalities were determined using Medicare Allowable rates. Medication costs were determined using the RedBook and indirect costs were calculated based on reported employment status and income. Quality Adjusted Life Years (QALY) was determined using the SF6D.

Results: There were 101 cases in the Operative (Op) and 103 in the Non-operative (Non-Op) group with complete eight year data. Thirty-eight patients (37%) in the Non-Op group had surgery from 3 to 72 months after enrollment. An As-Treated analysis including only cases who never had surgery (N=65) or cases with complete eight-year post-operative data (N=101) showed that operative treatment was favored with an ICER of $20,569 per QALY gained which is within Willingness-to-Pay (WTP) thresholds. An Intent-to-Treat analysis demonstrated greater QALY gains and lower cost in the Op group (ICER = $-13,911). However, Intent-to-Treat analysis is influenced by Non-Op patients who crossed over to operative treatment at variable times during follow-up.

Conclusion: Operative treatment was more cost-effective than non-operative treatment for ASLS at eight-year follow-up. The ICER continued to improve as compared to the five-year values ($20,569 vs. $44,033).