Presentations How Cost Effective Are Spine Interventions? | Page 4

Incremental cost-effectiveness of adult spinal deformity surgery:
observed quality-adjusted life years with surgery compared with
predicted quality-adjusted life years without surgery
´ RESULTS
Three-year follow-up was available for 120 (66%) of 181 eligible patients, who were
predominantly female (89%) with average age of 50. With discounting, total costs averaged
$125,407, including readmissions, with average QALYs of 1.93 at 3-year follow-up. Average
QALYs without surgery were predicted to be 1.6 after 3 years. At 3- and 5-year follow-up, the ICER
was $375,000 and $198,000, respectively. Projecting through 10-year follow-up, the ICER
was $80,000. The 10-year CEAC revealed a 40% probability that the ICER was $80,000 or less, a
90% probability that the ICER was $90,000 or less, and a 100% probability that the ICER was less
than $100,000.
´ CONCLUSIONS Based on the WHO's suggested upper threshold for cost-effectiveness (3 times per
capita GDP, or $140,000 in 2010 dollars), the analysis reveals that surgical treatment for ASD
is cost-effective after a 10-year period based on predicted deterioration in HRQOL without
surgery. The ICER well exceeds the WHO threshold at earlier follow-up intervals, highlighting the
importance of the durability of surgical treatment in assessing the value of surgical intervention.
Due to the study's methodology, the results are dependent on the predicted deterioration in HRQOL
without surgery. As such, the results may not extend to patients whose HRQOL would remain
steady without surgery. Future research should therefore pursue a direct comparison of QALYs for
surgical and nonsurgical patients to better understand the cost-effectiveness of surgery for the
average ASD patient.