Comparative effectiveness evidence from the spine patient outcomes research trial: Surgical versus nonoperative care for spinal stenosis, degenerative spondylolisthesis, and intervertebral disc herniation

Anna N.A. Tosteson*, Tor D. Tosteson, Jon D. Lurie, William Abdu, Harry Herkowitz, Gunnar Andersson, Todd Albert, Keith Bridwell, Wenyan Zhao, Margaret R. Grove, Milton C. Weinstein, James Neil Weinstein

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

164 Scopus citations

Abstract

Study Design: Cost-effectiveness analysis of a randomized plus observational cohort trial. Objective: Analyze cost-effectiveness of Spine Patient Outcomes Research Trial data over 4 years comparing surgery with nonoperative care for three common diagnoses: spinal stenosis (SPS), degenerative spondylolisthesis (DS), and intervertebral disc herniation (IDH). Summary of Background Data: Spine surgery rates continue to rise in the United States, but the safety and economic value of these procedures remain uncertain. Methods: Patients with image-confirmed diagnoses were followed in randomized or observational cohorts with data on resource use, productivity, and EuroQol EQ-5D health state values measured at 6 weeks, 3, 6, 12, 24, 36, and 48 months. For each diagnosis, cost per quality-adjusted life year (QALY) gained in 2004 US dollars was estimated for surgery relative to nonoperative care using a societal perspective, with costs and QALYs discounted at 3% per year. Results: Surgery was performed initially or during the 4-year follow-up among 414 of 634 (65.3%) SPS, 391 of 601 (65.1%) DS, and 789 of 1192 (66.2%) IDH patients. Surgery improved health, with persistent QALY differences observed through 4 years (SPS QALY gain 0.22; 95% confidence interval, CI: 0.15, 0.34; DS QALY gain 0.34, 95% CI: 0.30, 0.47; and IDH QALY gain 0.34, 95% CI: 0.31, 0.38). Costs per QALY gained decreased for SPS from $77,600 at 2 years to $59,400 (95% CI: $37,059, $125,162) at 4 years, for DS from $115,600 to $64,300 per QALY (95% CI: $32,864, $83,117), and for IDH from $34,355 to $20,600 per QALY (95% CI: $4,539, $33,088). Conclusion: Comparative effectiveness evidence for clearly defined diagnostic groups from Spine Patient Outcomes Research Trial shows good value for surgery compared with nonoperative care over 4 years.

Original languageEnglish (US)
Pages (from-to)2061-2068
Number of pages8
JournalSpine
Volume36
Issue number24
DOIs
StatePublished - Nov 15 2011

Keywords

  • Costeffectiveness
  • EQ-5D
  • QALY
  • SF-6D
  • degenerative spondylolisthesis
  • fusion surgery
  • instrumented fusion
  • intervertebral disc herniation
  • spinal stenosis

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Clinical Neurology

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