title: Cost-Effectiveness of Surgical Treatment for Adult Spinal Deformity: A Comparison of Dollars per Quality of Life Improvement Across Health Domains.
abstract: METHODS
  Retrospective, single-center analysis of consecutive patients undergoing surgical treatment for adult spinal deformity (ASD).
  
  
  OBJECTIVE
  Assess the value of surgical treatment for ASD across different health domains.
  
  
  BACKGROUND
  The cost of improvement in health-related quality of life (HRQOL) is an important consideration for resource allocation. There is also growing concern among policy makers regarding the incorporation of patient-specific preferences in the appropriate definition and assessment health care value.
  
  
  METHODS
  Single-center, retrospective study of consecutive ASD patients undergoing primary surgery with principal diagnosis code 737.0-737.9 from 2005 through May 2010. Patients less than 18 years of age were excluded. The HRQOL measures were based on the Short Form-36, the Oswestry Disability Index (ODI), and the Scoliosis Research Society (SRS)-22 questionnaire after at least 2 years after surgery. The SRS scores were translated to a 100-point scale. Costs were collected from hospital data on the total costs incurred for the episode of surgical care. Confidence intervals were calculated using nonparametric bootstrap methods.
  
  
  RESULTS
  Baseline and minimum 2-year HR follow-up data were available for 164 patients, with an average follow-up of 3.2 years and a range of 2 to 7.4 years. Patients were predominantly female (14; 88%) and ranged from 18 to 82 years of age at index surgery (average of 51 years of age). The cost-effectiveness (CE) ratios varied across different HRQOL outcomes, ranging from an average cost of $5,658 per 1-point improvement in SRS Self-image to an average cost of $25,918 per 1-point improvement in SF-36 Physical Component Score (PCS). Results revealed statistically significant differences (p < .05) in CE ratios across different HRQOL outcomes.
  
  
  CONCLUSIONS
  Statistically significant differences were found in CE ratios across HRQOL sub-domains. This has important implications in the assessment of patient-specific value of health care services, and illustrates that surgical treatment for ASD may be more cost-effective for some purposes (eg, pain reduction) and less cost-effective for others (eg, improved functional activity).
authors.affiliation: Institute for Health Care Research and Improvement, Baylor Health Care System, 8080 N. Central Expressway, Suite 500, Dallas, TX 75248, USA; Southern Methodist University, Dallas, TX, USA. Electronic address: ianmccarthy.econ@gmail.com.
authors.forename: Ian
authors.initials: I
authors.lastname: McCarthy
authors.affiliation: Baylor Scoliosis Center, Plano, TX, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Hostin
authors.affiliation: Baylor Scoliosis Center, Plano, TX, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: O'Brien
authors.affiliation: Institute for Health Care Research and Improvement, Baylor Health Care System, 8080 N. Central Expressway, Suite 500, Dallas, TX 75248, USA.
authors.forename: Neil
authors.initials: N
authors.lastname: Fleming
authors.affiliation: Institute for Health Care Research and Improvement, Baylor Health Care System, 8080 N. Central Expressway, Suite 500, Dallas, TX 75248, USA.
authors.forename: Gerald
authors.initials: G
authors.lastname: Ogola
authors.affiliation: Institute for Health Care Research and Improvement, Baylor Health Care System, 8080 N. Central Expressway, Suite 500, Dallas, TX 75248, USA.
authors.forename: Rustam
authors.initials: R
authors.lastname: Kudyakov
authors.affiliation: Institute for Health Care Research and Improvement, Baylor Health Care System, 8080 N. Central Expressway, Suite 500, Dallas, TX 75248, USA.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Richter
authors.affiliation: University of California San Francisco, San Francisco, CA, USA.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Saigal
authors.affiliation: University of California San Francisco, San Francisco, CA, USA.
authors.forename: Sigurd
authors.initials: S
authors.lastname: Berven
authors.affiliation: University of California San Francisco, San Francisco, CA, USA.
authors.forename: Vedat
authors.initials: V
authors.lastname: Deviren
authors.affiliation: University of California San Francisco, San Francisco, CA, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Ames
authors.affiliation: Denver, CO, USA.
keywords: Adult spinal deformity; Cost-effectiveness; Health care value; Health-related quality of life; Patient-specific preferences