title: Early Versus Delayed Surgical Decompression of Spinal Cord after Traumatic Cervical Spinal Cord Injury: A Cost-Utility Analysis.
abstract: OBJECTIVE
  This cost-utility analysis was undertaken to compare early (≤24 hours since trauma) versus delayed surgical decompression of spinal cord to determine which approach is more cost effective in the management of patients with acute traumatic cervical spinal cord injury (SCI).
  
  
  METHODS
  This study includes the patients enrolled into the Surgical Timing in Acute Spinal Cord Injury Study (STASCIS) and admitted at Toronto Western Hospital. Cases were grouped into patients with motor complete SCI and individuals with motor incomplete SCI. A cost-utility analysis was performed for each group of patients by the use of data for the first 6 months after SCI. The perspective of a public health care insurer was adopted. Costs were estimated in 2014 U.S. dollars. Utilities were estimated from the STASCIS.
  
  
  RESULTS
  The baseline analysis indicates early spinal decompression is more cost-effective approach compared with the delayed spinal decompression. When we considered the delayed spinal decompression as the baseline strategy, the incremental cost-effectiveness ratio analysis revealed a saving of US$ 58,368,024.12 per quality-adjusted life years gained for patients with complete SCI and a saving of US$ 536,217.33 per quality-adjusted life years gained in patients with incomplete SCI for the early spinal decompression. The probabilistic analysis confirmed the early-decompression strategy as more cost effective than the delayed-decompression approach, even though there is no clearly dominant strategy.
  
  
  CONCLUSIONS
  The results of this economic analysis suggests that early decompression of spinal cord was more cost effective than delayed surgical decompression in the management of patients with motor complete and incomplete SCI, even though no strategy was clearly dominant.
authors.affiliation: Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada; Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, ON, Canada; Lyndhurst Centre, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada. Electronic address: jcfurlan@gmail.com.
authors.forename: Julio C
authors.initials: JC
authors.lastname: Furlan
authors.affiliation: Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, ON, Canada; Lyndhurst Centre, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.
authors.forename: B Catharine
authors.initials: BC
authors.lastname: Craven
authors.affiliation: Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada; Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Massicotte
authors.affiliation: Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada; Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Toronto, ON, Canada; Krembil Neuroscience Centre, Spinal Program, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Fehlings
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D015984:Causality; D002574:Cervical Vertebrae / Q000293:injuries*; D015897:Comorbidity; D003362:Cost-Benefit Analysis / Q000191:economics; D019299:Decompression, Surgical / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D011183:Postoperative Complications / Q000191:economics* / Q000453:epidemiology; D015995:Prevalence; D011788:Quality of Life; D012189:Retrospective Studies; D018570:Risk Assessment; D055502:Secondary Prevention / Q000191:economics / Q000706:statistics & numerical data; D013116:Spinal Cord / Q000601:surgery; D013119:Spinal Cord Injuries / Q000191:economics* / Q000453:epidemiology / Q000601:surgery*; D016896:Treatment Outcome; D014481:United States
keywords: Cost-utility analysis; Costs; Economics; Rehabilitation; Spinal cord decompression; Spinal cord injury; Spine surgery; Timing; Trauma; Utility