Cost-utility analysis of cervical deformity surgeries using one-year outcome

Publication date: Available online 27 February 2018
Source:The Spine Journal
Author(s): Gregory W. Poorman, Peter G. Passias, Rabia Qureshi, Hamid Hassanzadeh, Samantha Horn, Cole Bortz, Frank Segreto, Amit Jain, Michael Kelly, Richard Hostin, Christopher Ames, Justin Smith, Virginie LaFage, Douglas Burton, Shay Bess, Chris Shaffrey, Frank Schwab, Munish Gupta
ObjectCost-utility analysis, a special case of cost-effectiveness analysis, estimates the ratio between the cost of an intervention to the benefit it produces in number of quality-adjusted life years. Cervical deformity correction has not been evaluated in terms of cost-utility and in the context of value-based health care. Our objective, therefore, was to determine the cost-utility ratio of cervical deformity correction.MethodsRetrospective review of a prospective, multicenter cervical deformity database. Patients with 1-year follow-up after surgical correction for cervical deformity were included. Cervical deformity was defined as the presence of at least one of the following: kyphosis (C2-7 Cobb angle >10°), cervical scoliosis (coronal Cobb angle >10°), positive cervical sagittal malalignment (C2-C7 sagittal vertical axis >4cm or T1-C6 >10 ^o), or horizontal gaze impairment (chin-brow vertical angle >25^o). Quality adjusted life years were calculated by both EuroQol 5D (EQ5D) quality of life and NDI mapped to SF6D index. Costs were assigned using Medicare 1-year average reimbursement for: 9+ level posterior fusions (PF), 4-8 level PF, 4-8 level PF with anterior fusion (AF), 2-3 level PF with AF, 4-8 level AF, and 4-8 level posterior refusion. Reoperations and deaths were added to cost and subtracted from utility respectively. QALY per dollar spent was calculated using standardized methodology at 1-year time point and subsequent time-points relying on maintenance of 1-year utility.Results84 patients (average age: 61.2 years, 60% female, BMI: 30.1) were analyzed after cervical deformity correction (average levels fused: 7.2, osteotomy used: 50%. Costs associated with index procedures were: 9+ level PF ($76,617), 4-8 level PF ($40,596), 4-8 level PF with AF ($67,098), 4-8 level AF ($31,392) and 4-8 level posterior refusion ($35,371). Average 1-year reimbursement of surgery was $55,097 at 1-year with 8 revisions and 3 deaths accounted for. Cost per QALY gained to 1-year follow-up was $646,958 by eq5d and $477,316 by NDI SF6D. If 1-year benefit is sustained, upper threshold of cost-effectiveness is reached 3-4.5 years after intervention.ConclusionsMedicare 1-year average reimbursement compared to 1-year quality adjusted life year described $646,958 by eq5d and $477,316 by NDI SF6D. Cervical deformity surgeries reach accepted costeffectiveness thresholds when benefit is sustained 3-4.5 years. Longer follow-up is needed for a more definitive cost-analysis, but this data is an important first step in justifying cost-utility ratio for cervical deformity correction.



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