title: A Cost-Utility Analysis of Lumbar Decompression With and Without Fusion for Degenerative Spine Disease in the Elderly.
abstract: BACKGROUND
  Value-based purchasing is rapidly being implemented to rein in the unsustainably rising costs of the US healthcare system. With a growing elderly population, it is vital to understand the value of spinal surgery in this group of individuals.
  
  
  OBJECTIVE
  To compare the cost-effectiveness of lumbar decompression with and without fusion for degenerative spine disease in elderly vs nonelderly patients.
  
  
  METHODS
  A total of 221 patients undergoing elective primary surgery for degenerative lumbar pathology who were enrolled in a prospective longitudinal registry were analyzed. Patient-reported outcomes of Oswestry Disability Index, numeric rating scale for back and leg pain, and quality-of-life scores (EuroQol-5D) were recorded. Two-year back-related medical resource use, missed work, and health-state values (quality-adjusted life-years [QALYs]) were assessed. Two-year resource use was multiplied by unit costs based on Medicare national allowable payment amounts (direct cost). Patient and caregiver workday losses were multiplied by gross-of-tax wage rate (indirect cost). Patients were divided into age groups <70 and ≥70 years.
  
  
  RESULTS
  Mean cumulative 2-year QALYs gained were statistically similar between younger and older patients for both decompression alone (0.67 ± 0.65 vs 0.56 ± 0.65; P = .47) and decompression with fusion (0.56 ± 0.55 vs 0.59 ± 0.55; P = .26). Mean 2-year cost per QALY gained between younger and older patients was similar for both decompression alone ($24,365 vs $31,750 per QALY; P = .11) and decompression with fusion ($64,228 vs $60,183 per QALY; P = .09).
  
  
  CONCLUSIONS
  Surgical treatment provided significant improvements in pain, disability, and quality of life for elderly patients with degenerative lumbar disease. Observed costs per QALY gained for lumbar decompression with and without fusion were similar for younger and older patients, demonstrating that lumbar spine surgery in the elderly is an equally cost-effective and valuable intervention.
authors.affiliation: *Department of Orthopedics Surgery and Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee; ‡Division of Neurosurgery and Spine Program, Toronto Western Hospital, University Health Network, University of Toronto, Institute of Medical Sciences, Toronto, Ontario, Canada; §Department of Neurological Surgery, Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina.
authors.forename: Clinton J
authors.initials: CJ
authors.lastname: Devin
authors.forename: Silky
authors.initials: S
authors.lastname: Chotai
authors.forename: Scott L
authors.initials: SL
authors.lastname: Parker
authors.forename: Lindsay
authors.initials: L
authors.lastname: Tetreault
authors.forename: Michael G
authors.initials: MG
authors.lastname: Fehlings
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: McGirt
mesh_terms: D000367:Age Factors; D000368:Aged; D003362:Cost-Benefit Analysis; D019299:Decompression, Surgical / Q000191:economics* / Q000379:methods; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D006278:Medicare; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012042:Registries; D013123:Spinal Fusion / Q000191:economics* / Q000379:methods; D055009:Spondylosis / Q000191:economics* / Q000601:surgery; D016896:Treatment Outcome; D014481:United States