Surgical treatment of spinal stenosis with and without degenerative spondylolisthesis: cost-effectiveness after 2 years.
BACKGROUND
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.


OBJECTIVE
To assess the short-term cost-effectiveness of spine surgery relative to nonoperative care for stenosis alone and for stenosis with spondylolisthesis.


METHODS
Prospective cohort study.


METHODS
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.


METHODS
Patients with image-confirmed spinal stenosis, with and without degenerative spondylolisthesis.


METHODS
2 years.


CONCLUSIONS
Societal.


METHODS
Nonoperative care or surgery (primarily decompressive laminectomy for stenosis and decompressive laminectomy with fusion for stenosis associated with degenerative spondylolisthesis).


METHODS
Cost per quality-adjusted life-year (QALY) gained.


RESULTS
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 $77,600 (CI, $49,600 to $120,000) 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 $115,600 (CI, $90,800 to $144,900) per QALY gained. RESULT OF SENSITIVITY ANALYSIS: Surgery cost markedly affected the value of surgery.


CONCLUSIONS
The study used self-reported utilization data, 2-year time horizon, and as-treated analysis to address treatment nonadherence among randomly assigned participants.


CONCLUSIONS
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.
Tosteson
Anna N A
AN
Multidisciplinary Clinical Research Center in Musculoskeletal Diseases, Dartmouth Medical School, Hanover, New Hampshire 03756, USA.
Lurie
Jon D
JD
Tosteson
Tor D
TD
Skinner
Jonathan S
JS
Herkowitz
Harry
H
Albert
Todd
T
Boden
Scott D
SD
Bridwell
Keith
K
Longley
Michael
M
Andersson
Gunnar B
GB
Blood
Emily A
EA
Grove
Margaret R
MR
Weinstein
James N
JN
D000041:Absenteeism; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D019299:Decompression, Surgical / Q000191:economics; D005260:Female; D005102:Health Expenditures; D006801:Humans; D007796:Laminectomy / Q000191:economics; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019057:Quality-Adjusted Life Years; D013123:Spinal Fusion / Q000191:economics; D013130:Spinal Stenosis / Q000191:economics* / Q000601:surgery*; D013168:Spondylolisthesis / Q000191:economics* / Q000601:surgery*; D016896:Treatment Outcome