Cost per quality-adjusted life year gained of revision fusion for lumbar pseudoarthrosis

Owoicho Adogwa, Scott L. Parker, David Shau, Stephen K. Mendelhall, Oran Aaronson, Joseph Cheng, Clinton J. Devin, Matthew J. Mcgirt

Research output: Contribution to journalArticlepeer-review

29 Scopus citations


Study Design: Single cohort study of patients undergoing revision fusion for lumbar pseudoarthrosis. Objective: To assess the 2-year comprehensive costs of revision arthrodesis for lumbar pseudoarthrosis at our institution and determine the associated cost per quality-adjusted life year (QALY) gained in this patient population. Summary of Background Data: The proportion of lumbar spine operations involving a fusion procedure has increased over the past 2 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 (QALYs, calculated from EuroQuol 5D with US 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). The mean total 2-year cost per QALY gained after revision surgery was assessed. Results: The mean (±SD) duration of time between prior fusion and development of symptomatic pseudoarthrosis was 2.69±3.09 years. None of the patients developed symptomatic pseudoarthrosis after 2 years of revision surgery. A mean cumulative 2-year gain of 0.35 QALYs was reported. The mean (±SD) total 2-year cost of revision fusion was 41,631±9691 (surgery cost: 23,865±270; outpatient resource utilization cost: 4885±2301; indirect cost: 12,879±8171). Revision instrumented arthrodesis was associated with a mean 2-year cost per QALY gained of 118,945. Conclusions: Revision arthrodesis was associated with improved 2-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.

Original languageEnglish (US)
Pages (from-to)101-105
Number of pages5
JournalJournal of Spinal Disorders and Techniques
Issue number3
StatePublished - Apr 7 2015
Externally publishedYes


  • cost per quality
  • cost-effectiveness
  • failed back surgery
  • lumbar fusion
  • pseudoarthrosis
  • revision
  • value

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine
  • Clinical Neurology


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