title: Cost-effectiveness of surgery plus radiotherapy versus radiotherapy alone for metastatic epidural spinal cord compression.
abstract: 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.
authors.affiliation: Department of Surgery (Orthopedics), University of Calgary, Calgary, AB, Canada.
authors.forename: Kenneth C
authors.initials: KC
authors.lastname: Thomas
authors.forename: Bohdan
authors.initials: B
authors.lastname: Nosyk
authors.forename: Charles G
authors.initials: CG
authors.lastname: Fisher
authors.forename: Marcel
authors.initials: M
authors.lastname: Dvorak
authors.forename: Roy A
authors.initials: RA
authors.lastname: Patchell
authors.forename: William F
authors.initials: WF
authors.lastname: Regine
authors.forename: Andrew
authors.initials: A
authors.lastname: Loblaw
authors.forename: Nick
authors.initials: N
authors.lastname: Bansback
authors.forename: Daphne
authors.initials: D
authors.lastname: Guh
authors.forename: Huiying
authors.initials: H
authors.lastname: Sun
authors.forename: Aslam
authors.initials: A
authors.lastname: Anis
mesh_terms: 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*