title: Cost-Utility Analysis of Pedicle Screw Removal After Successful Posterior Instrumented Fusion in Thoracolumbar Burst Fractures.
abstract: METHODS
  A cost-utility analysis (CUA).
  
  
  OBJECTIVE
  The aim of this study was to determine the cost-effectiveness of pedicle screw removal after posterior fusion in thoracolumbar burst fractures.
  
  
  BACKGROUND
  Pedicle screw instrumentation is a standard fixation method for unstable thoracolumbar burst fracture. However, removal of the pedicle screw after successful fusion remains controversial because the clinical benefits remain unclear. CUA can help clinicians make appropriate decisions about optimal health care for pedicle screw removal after successful fusion in thoracolumbar burst fractures.
  
  
  METHODS
  We conducted a single-center, retrospective, longitudinal matched-cohort study of prospectively collected outcomes. In total, 88 consecutive patients who had undergone pedicle screw instrumentation for thoracolumbar burst fracture with successful fusion confirmed by computed tomography (CT) were used in this study. In total, 45 patients wanted to undergo implant removal surgery (R group), and 43 decided not to remove the implant (NR group). A CUA was conducted from the health care perspective. The direct costs of health care were obtained from the medical bill of each patient. Changes in health-related quality of life (HRQoL) scores, validated by Short Form 6D, were used to calculate quality-adjusted life-years (QALYs). Total costs and gained QALY were calculated at 1 year (1 year) and 2 years (2 years) compared with baseline. Results are expressed as an incremental cost-effectiveness ratio (ICER). Different discount rates (0%, 3%, and 5%) were applied to both cost and QALY for sensitivity analysis.
  
  
  RESULTS
  Baseline patient variables were similar between the two groups (all P > 0.05). The additional benefits of implant removal (0.201 QALY at 2 years) were achieved with additional costs ($2541 at 2 years), equating to an ICER of $12,641/QALY. On the basis of the different discount rates, the robustness of our study's results was also determined.
  
  
  CONCLUSIONS
  Implant removal after successful fusion in a thoracolumbar burst fracture is cost-effective until postoperative year 2.
  
  
  METHODS
  3.
authors.affiliation: Department of Orthopaedic Surgery, Ajou University School of Medicine, Suwon, South Korea.
authors.forename: Han-Dong
authors.initials: HD
authors.lastname: Lee
authors.forename: Chang-Hoon
authors.initials: CH
authors.lastname: Jeon
authors.forename: Nam-Su
authors.initials: NS
authors.lastname: Chung
authors.forename: Young-Wook
authors.initials: YW
authors.lastname: Seo
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis / Q000639:trends; D020878:Device Removal / Q000191:economics* / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D005592:Fracture Fixation / Q000191:economics / Q000639:trends; D006801:Humans; D008137:Longitudinal Studies; D008159:Lumbar Vertebrae / Q000293:injuries* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D065289:Pedicle Screws / Q000191:economics* / Q000639:trends; D011446:Prospective Studies; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000191:economics* / Q000601:surgery; D013123:Spinal Fusion / Q000191:economics* / Q000639:trends; D013904:Thoracic Vertebrae / Q000293:injuries* / Q000601:surgery