3. Objective—To assess the short-term cost-effectiveness of spine
surgery relative to nonoperative care for stenosis alone and for
stenosis with spondylolisthesis.
Design—Prospective cohort study.
Data Sources—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.
Target Population—Patients with image-confirmed spinal stenosis,
with and without degenerative spondylolisthesis.
Time Horizon—2 years.
4. Intervention—Nonoperative care or surgery (primarily
decompressive laminectomy for stenosis and decompressive
laminectomy with fusion for stenosis associated with
degenerative Spondylolisthesis).
Outcome Measures—Cost per quality-adjusted life-year
(QALY) gained.
5. Objective—To assess the short-term cost-effectiveness of spine surgery
relative to nonoperative care for stenosis alone and for stenosis with
spondylolisthesis.
6. Target Population—Patients with image-confirmed spinal stenosis, with
and without degenerative spondylolisthesis.
Intervention—Nonoperative care or surgery (primarily decompressive
laminectomy for stenosis and decompressive laminectomy with fusion for
stenosis associated with degenerative Spondylolisthesis).
7.
8. The Spine Patient Outcomes Research Trial compared surgical and non-
surgical treatments for intervertebral disc herniation (IDH), spinal
stenosis (SpS) and degenerative spondylolisthesis (DS). Approximately
2500 patients took part in the study, which was conducted at 13 sites
across the country. Reported favorable surgery outcomes over 2 years
The results of SPORT were released in three phases:
1. Intervertebral disc herniation, published in JAMA, November, 2006
2. Degenerative Spondylolisthesis, published in The New England
Journal of Medicine, May, 2007
3. Spinal Stenosis, published in The New England Journal of Medicine,
February 21, 2008
11. To measure health outcomes, QALYs were used to account for both quality and length
of life.
QALYs were assessed at baseline; 6 weeks; and 3, 6, 12, and 24 months with EuroQol
EQ-5D
Health care diaries helped participants track resource use and work or activities.
- Direct Medical Costs
Included any emergency department or outpatient visit, imaging, injections, etc
- Indirect Costs
The effect of spine-related problems on productivity, missed work days, missed
housekeeping days
QALY = Quality Adjusted Life Year
12. 1. Relied on Medicare payment schedules to estimate medical
costs.
2. Estimated costs by using the standard human capital approach
of multiplying the change in hours worked by the gross of tax
wage rate, on the basis of self-reported wages at study entry
13. “We estimated mean total costs and QALYs from baseline to 2 years
for each diagnosis and treatment group by using a 3% annualized discount
rate for both end points”
14.
15. “Sensitivity analyses of analytic assumptions included restricting analyses to the
randomized or observational cohort, limiting cost type, increasing surgery costs to 70%
of the amount billed to Medicare, using the Short Form-6D (SF-6D) to estimate
effectiveness, and accounting for observed mortality”
16.
17.
18.
19.
20.
21. 4 Year f/u Study
"Comparative effectiveness evidence from the spine patient outcomes
research trial: surgical versus nonoperative care for spinal stenosis,
degenerative spondylolisthesis, and intervertebral disc herniation."
Spine 2011;36:2061-8.
Results. Surgery was performed initially or during the 4-year follow-up among 414 of
634 (65.3%) SPS, 391 of 601 (65.1%) DS, and 789 of 1192 (66.2%) IDH patients.
Surgery improved health, with persistent QALY differences observed through 4 years
(SPS QALY gain 0.22; 95% confidence interval, CI: 0.15, 0.34; DS QALY gain 0.34,
95% CI: 0.30, 0.47; and IDH QALY gain 0.34, 95% CI: 0.31, 0.38). Costs per QALY
gained decreased for SPS from $77,600 at 2 years to $59,400 (95% CI: $37,059,
$125,162) at 4 years, for DS from $115,600 to $64,300 per QALY (95% CI: $32,864,
$83,117), and for IDH from $34,355 to $20,600 per QALY (95% CI: $4,539,
$33,088).
22. "Surgical versus Non-Operative Treatment for Lumbar Disk Herniation: Eight-year Results for
the Spine Patient Outcomes Research Trial (SPORT)" Spine 39(1):3-16, 2014.
