Anna N.A. Tosteson, ScD; Jon D. Lurie, MD, MS; Tor D. Tosteson, ScD; Jonathan S. Skinner, PhD; Harry Herkowitz, MD; Todd Albert, MD; Scott D. Boden, MD; Keith Bridwell, MD, PhD; Michael Longley, MD; Gunnar B. Andersson, MD, PhD; Emily A. Blood, MS; Margaret R. Grove, MS; James N. Weinstein, DO, MS; SPORT Investigators
Tosteson AN, Lurie JD, Tosteson TD, Skinner JS, Herkowitz H, Albert T, et al. Surgical Treatment of Spinal Stenosis with and without Degenerative Spondylolisthesis: Cost-Effectiveness after 2 Years. Ann Intern Med. 2008;149:845-853. doi: 10.7326/0003-4819-149-12-200812160-00003
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Published: Ann Intern Med. 2008;149(12):845-853.
The SPORT (Spine Patient Outcomes Research Trial) reported favorable surgery outcomes over 2 years among patients with stenosis with and without degenerative spondylolisthesis, but the economic value of these surgeries is uncertain.
To assess the short-term cost-effectiveness of spine surgery relative to nonoperative care for stenosis alone and for stenosis with spondylolisthesis.
Prospective cohort study.
Resource utilization, productivity, and EuroQol EQ-5D score measured at 6 weeks and at 3, 6, 12, and 24 months after treatment among SPORT participants.
Patients with image-confirmed spinal stenosis, with and without degenerative spondylolisthesis.
Nonoperative care or surgery (primarily decompressive laminectomy for stenosis and decompressive laminectomy with fusion for stenosis associated with degenerative spondylolisthesis).
Cost per quality-adjusted life-year (QALY) gained.
Among 634 patients with stenosis, 394 (62%) had surgery, most often decompressive laminectomy (320 of 394 [81%]). Stenosis surgeries improved health to a greater extent than nonoperative care (QALY gain, 0.17 [95% CI, 0.12 to 0.22]) at a cost of $77Â 600 (CI, $49Â 600 to $120Â 000) per QALY gained. Among 601 patients with degenerative spondylolisthesis, 368 (61%) had surgery, most including fusion (344 of 368 [93%]) and most with instrumentation (269 of 344 [78%]). Degenerative spondylolisthesis surgeries significantly improved health versus nonoperative care (QALY gain, 0.23 [CI, 0.19 to 0.27]), at a cost of $115Â 600 (CI, $90Â 800 to $144Â 900) per QALY gained.
Surgery cost markedly affected the value of surgery.
The study used self-reported utilization data, 2-year time horizon, and as-treated analysis to address treatment nonadherence among randomly assigned participants.
The economic value of spinal stenosis surgery at 2 years compares favorably with many health interventions. Degenerative spondylolisthesis surgery is not highly cost-effective over 2 years but could show value over a longer time horizon.
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