title: Surgical treatment of spinal stenosis with and without degenerative spondylolisthesis: cost-effectiveness after 2 years.
abstract: 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.
authors.affiliation: Multidisciplinary Clinical Research Center in Musculoskeletal Diseases, Dartmouth Medical School, Hanover, New Hampshire 03756, USA.
authors.forename: Anna N A
authors.initials: AN
authors.lastname: Tosteson
authors.forename: Jon D
authors.initials: JD
authors.lastname: Lurie
authors.forename: Tor D
authors.initials: TD
authors.lastname: Tosteson
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Skinner
authors.forename: Harry
authors.initials: H
authors.lastname: Herkowitz
authors.forename: Todd
authors.initials: T
authors.lastname: Albert
authors.forename: Scott D
authors.initials: SD
authors.lastname: Boden
authors.forename: Keith
authors.initials: K
authors.lastname: Bridwell
authors.forename: Michael
authors.initials: M
authors.lastname: Longley
authors.forename: Gunnar B
authors.initials: GB
authors.lastname: Andersson
authors.forename: Emily A
authors.initials: EA
authors.lastname: Blood
authors.forename: Margaret R
authors.initials: MR
authors.lastname: Grove
authors.forename: James N
authors.initials: JN
authors.lastname: Weinstein
mesh_terms: 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