Is Surgery for Cervical Spondylotic Myelopathy Cost-Effective?Eric Woodard, MD1, Branko Kopjar1, Michael Fehlings, MD1, Sangwook Yoon, MD1, Paul Arnold, MD1, Eric Massicotte, MD1, Alexander Vaccaro, MD1, Darrel Brodke, MD1, Christopher Shaffrey, MD1, Robert Banco, MD1, Jens Chapman, MD1, Michael Janssen1, Christopher Bono, MD1, Rick Sasso, MD1, Mark Dekutoski, MD1, Ziya Gokaslan, MD1, Neilank Jha1, Stephanie Hewson11Seattle, WA United States Keywords: cost effectiveness, spinal stenosis, cervical spine, myelopathy, outcomeInteractive ManuscriptAsk Questions of this Manuscript: What is the background behind your study?Surgical intervention for appropriately-selected patients with cervical spondylotic myelopathy (CSM) has demonstrated favourable outcomes. However, the cost-effectiveness of this intervention is unclear. What is the purpose of your study?This study evaluates the cost-effectiveness of surgery for CSM based on Quality-Adjusted Life Year (QALY) gained, based on data obtained from the AOSpine North America Prospective Multicentre CSM Study. Describe your patient group.. Describe what you did.As part of a larger prospective multi-centre study, direct costs of medical treatment data for 71 subjects undergoing surgery for CSM at a single institution were retrospectively obtained from the hospital billing data. Utilities were estimated on the entire sample of 278 subjects enrolled in the study using SF-6D derived utilities from 12- and 24-month follow-up information. A ten-year horizon with 3% discounting was applied to health utilities estimates Describe your main findings.The SF-6D scores improved significantly (mean change: .0734; 95% C.I. .0557 to .0912, P < .01) at 12 months andremained unchanged at 24 months. The ten-year discounted QALY gain was .64. Costs of medical treatment were estimated at an average of $21,066 CDN. The estimated cost-utility ratio was calculated as $32,916 CDN per QALY. The sensitivity analysis showed a range from $27,326 to $40,988. These estimates are within the limits of $50,000 for interventions with an acceptable cost-utility ratio. Describe the main limitation of this study.This is a retrospective study. Describe your main conclusion.Surgery for CSM is associated with statistically significant improvement in utility scores as measured by the SF-6D variable. Describe the importance of your findings and how they can be used by others.The cost per QALY gained would indicate that surgery for CSM is also an acceptable cost effective procedure. Surgical intervention for appropriately-selected patients with cervical spondylotic myelopathy (CSM) has demonstrated favourable outcomes. However, the cost-effectiveness of this intervention is unclear. This study evaluates the cost-effectiveness of surgery for CSM based on Quality-Adjusted Life Year (QALY) gained, based on data obtained from the AOSpine North America Prospective Multicentre CSM Study. . As part of a larger prospective multi-centre study, direct costs of medical treatment data for 71 subjects undergoing surgery for CSM at a single institution were retrospectively obtained from the hospital billing data. Utilities were estimated on the entire sample of 278 subjects enrolled in the study using SF-6D derived utilities from 12- and 24-month follow-up information. A ten-year horizon with 3% discounting was applied to health utilities estimates The SF-6D scores improved significantly (mean change: .0734; 95% C.I. .0557 to .0912, P < .01) at 12 months andremained unchanged at 24 months. The ten-year discounted QALY gain was .64. Costs of medical treatment were estimated at an average of $21,066 CDN. The estimated cost-utility ratio was calculated as $32,916 CDN per QALY. The sensitivity analysis showed a range from $27,326 to $40,988. These estimates are within the limits of $50,000 for interventions with an acceptable cost-utility ratio. This is a retrospective study. Surgery for CSM is associated with statistically significant improvement in utility scores as measured by the SF-6D variable. The cost per QALY gained would indicate that surgery for CSM is also an acceptable cost effective procedure. Project Roles:
E. Woodard (), B. Kopjar (), M. Fehlings (), S. Yoon (), P. Arnold (), E. Massicotte (), A. Vaccaro (), D. Brodke (), C. Shaffrey (), R. Banco (), J. Chapman (), M. Janssen (), C. Bono (), R. Sasso (), M. Dekutoski (), Z. Gokaslan (), N. Jha (), S. Hewson ()
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