TY - JOUR
T1 - A cost utility analysis of treating different adult spinal deformity frailty states
AU - Brown, Avery E.
AU - Lebovic, Jordan
AU - Alas, Haddy
AU - Pierce, Katherine E.
AU - Bortz, Cole A.
AU - Ahmad, Waleed
AU - Naessig, Sara
AU - Hassanzadeh, Hamid
AU - Labaran, Lawal A.
AU - Puvanesarajah, Varun
AU - Vasquez-Montes, Dennis
AU - Wang, Erik
AU - Raman, Tina
AU - Diebo, Bassel G.
AU - Vira, Shaleen
AU - Protopsaltis, Themistocles S.
AU - Lafage, Virginie
AU - Lafage, Renaud
AU - Buckland, Aaron J.
AU - Gerling, Michael C.
AU - Passias, Peter G.
N1 - Publisher Copyright:
© 2020 Elsevier Ltd
PY - 2020/10
Y1 - 2020/10
N2 - The aim of this study was to investigate the cost utility of treating non-frail versus frail or severely frail adult spinal deformity (ASD) patients. 79 surgical ASD patients >18 years with available frailty and ODI data at baseline and 2-years post-surgery (2Y) were included. Utility data was calculated using the ODI converted to the SF-6D. QALYs utilized a 3% discount rate to account for decline to life expectancy (LE). Costs were calculated using the PearlDiver database. ICER was compared between non-operative (non-op.) and operative (op.) NF and F/SF patients at 2Y and LE. When compared to non-operative ASD, the ICER was $447,943.96 vs. $313,211.01 for NF and F/SF at 2Y, and $68,311.35 vs. $47,764.61 for NF and F/SF at LE. Frail and severely frail patients had lower cost per QALY compared to not frail patients at 2Y and life expectancy, and had lower ICER values when compared to a non-operative cohort of ASD patients. While these results support operative correction of frail and severely frail patients, it is important to note that these patients are often at worse baseline disability, which is closely related to frailty scores, and have more opportunity to improve postoperatively. Furthermore, there may be a threshold of frailty that is not operable due to the risk of severe complications that is not captured by this analysis. While future research should investigate economic outcomes at extended follow up times, these findings support the cost effectiveness of ASD surgery at all frailty states.
AB - The aim of this study was to investigate the cost utility of treating non-frail versus frail or severely frail adult spinal deformity (ASD) patients. 79 surgical ASD patients >18 years with available frailty and ODI data at baseline and 2-years post-surgery (2Y) were included. Utility data was calculated using the ODI converted to the SF-6D. QALYs utilized a 3% discount rate to account for decline to life expectancy (LE). Costs were calculated using the PearlDiver database. ICER was compared between non-operative (non-op.) and operative (op.) NF and F/SF patients at 2Y and LE. When compared to non-operative ASD, the ICER was $447,943.96 vs. $313,211.01 for NF and F/SF at 2Y, and $68,311.35 vs. $47,764.61 for NF and F/SF at LE. Frail and severely frail patients had lower cost per QALY compared to not frail patients at 2Y and life expectancy, and had lower ICER values when compared to a non-operative cohort of ASD patients. While these results support operative correction of frail and severely frail patients, it is important to note that these patients are often at worse baseline disability, which is closely related to frailty scores, and have more opportunity to improve postoperatively. Furthermore, there may be a threshold of frailty that is not operable due to the risk of severe complications that is not captured by this analysis. While future research should investigate economic outcomes at extended follow up times, these findings support the cost effectiveness of ASD surgery at all frailty states.
KW - Adult spinal deformity
KW - Cost-utility
KW - Frailty
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U2 - 10.1016/j.jocn.2020.07.047
DO - 10.1016/j.jocn.2020.07.047
M3 - Article
C2 - 33099349
AN - SCOPUS:85089835260
SN - 0967-5868
VL - 80
SP - 223
EP - 228
JO - Journal of Clinical Neuroscience
JF - Journal of Clinical Neuroscience
ER -