Cost-effectiveness of surgery plus radiotherapy versus radiotherapy alone for metastatic epidural spinal cord compression.
OBJECTIVE
A recent randomized clinical trial has demonstrated that direct decompressive surgery plus radiotherapy was superior to radiotherapy alone for the treatment of metastatic epidural spinal cord compression. The current study compared the cost-effectiveness of the two approaches.


METHODS
In the original clinical trial, clinical effectiveness was measured by ambulation and survival time until death. In this study, an incremental cost-effectiveness analysis was performed from a societal perspective. Costs related to treatment and posttreatment care were estimated and extended to the lifetime of the cohort. Weibull regression was applied to extrapolate outcomes in the presence of censored clinical effectiveness data.


RESULTS
From a societal perspective, the baseline incremental cost-effectiveness ratio (ICER) was found to be $60 per additional day of ambulation (all costs in 2003 Canadian dollars). Using probabilistic sensitivity analysis, 50% of all generated ICERs were lower than $57, and 95% were lower than $242 per additional day of ambulation. This analysis had a 95% CI of -$72.74 to 309.44, meaning that this intervention ranged from a financial savings of $72.74 to a cost of $309.44 per additional day of ambulation. Using survival as the measure of effectiveness resulted in an ICER of $30,940 per life-year gained.


CONCLUSIONS
We found strong evidence that treatment of metastatic epidural spinal cord compression with surgery in addition to radiotherapy is cost-effective both in terms of cost per additional day of ambulation, and cost per life-year gained.
Thomas
Kenneth C
KC
Department of Surgery (Orthopedics), University of Calgary, Calgary, AB, Canada.
Nosyk
Bohdan
B
Fisher
Charles G
CG
Dvorak
Marcel
M
Patchell
Roy A
RA
Regine
William F
WF
Loblaw
Andrew
A
Bansback
Nick
N
Guh
Daphne
D
Sun
Huiying
H
Anis
Aslam
A
D002170:Canada / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D015174:Epidural Neoplasms / Q000191:economics / Q000453:epidemiology / Q000556:secondary / Q000628:therapy; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D019635:Neurosurgical Procedures / Q000191:economics* / Q000706:statistics & numerical data; D011878:Radiotherapy / Q000191:economics* / Q000706:statistics & numerical data; D016032:Randomized Controlled Trials as Topic; D013117:Spinal Cord Compression / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*