Cost Per Quality-adjusted Life Year Gained of Revision Lumbar Surgery for Adjacent Segment Disease, Pseudoarthrosis, and Same-level Recurrent Stenosis: Defining the Value of Surgical Intervention

Scott Parker, MD1, David Shau1, Stephen Mendenhall1, Owoicho Adogwa1, Joseph Cheng1, Clinton Devin1, Matthew McGirt1

1Nashville, TN United States

Keywords: cost effectiveness, lumbar spine, lumbar diskectomy, spinal fusion, spinal stenosis

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     The cost-effectiveness of revision surgery for failed back surgery syndrome (FBSS) remains unclear.
     We set out to assess cost-effectiveness of revision surgery for adjacent segment disease (ASD), pseudoarthrosis, and same-level recurrent stenosis over a two-year follow-up period.
     150 patients undergoing revision neural decompression and instrumented fusion for adjacent segment disease(ASD, n=50), pseudoarthrosis(n=47), or same-level recurrent stenosis(n=53) were included.
     Two-year patient-reported outcomes (PRO), back-related medical resource utilization, and work-day losses were prospectively assessed via phone interview and used to calculate Medicare fee-based direct cost and indirect costs from occupation loss. Mean total two-year cost per QALY gained after revision surgery was assessed.
     Pre-operative EQ-5D for patients with ASD, pseudoarthrosis, and same-level recurrent stenosis was 0.30±0.28, 0.37±0.17, and 0.18±0.22, respectively. Mean cumulative two-year health-state gain for these 3 cohorts following surgery was 0.76 QALYs, 0.35 QALYs, and 0.84 QALYs, respectively. Mean±SD total two-year cost of surgery following ASD, pseudoarthrosis, and same-level stenosis was $47,846±32,712, $41,631±$9,691, and $49,431±7,583, respectively. Revision surgery for ASD, pseudoarthrosis, and same-level stenosis was associated with mean two-year cost per QALY gained of $62,955, $118,945, and $58,846, respectively.
     This is a retrospective study.
     Revision fusion for FBSS was associated with significant improvement in quality of life at two years. Surgical management of adjacent segment disease and same-level recurrent stenosis were shown to be cost-effective at $62,955 and $58,846 per QALY gained, respectively.
     Surgery for pseudoarthrosis was shown to be poorly cost-effective at $118,945 per QALY gained. Our results suggest that revision neural decompression and fusion for FBSS is a valuable treatment option.


Project Roles:

S. Parker (), D. Shau (), S. Mendenhall (), O. Adogwa (), J. Cheng (), C. Devin (), M. McGirt ()