Comparison of lifetime incremental cost:utility ratios of surgery relative to failed medical management for the treatment of hip, knee and spine osteoarthritis modelled using 2-year postsurgical values

Abstract

Comparison of lifetime incremental cost:utility ratios of surgery relative to failed medical management for the treatment of hip, knee and spine osteoarthritis modelled using 2-year postsurgical values Background: Demand for surgery to treat osteoarthritis (OA) of the hip, knee and spine has risen dramatically. Whereas total hip (THA) and total knee arthroplasty (TKA) have been widely accepted as cost-effective, spine surgeries (decompression, decompression with fusion) to treat degenerative conditions remain underfunded compared with other surgeries.Methods: An incremental cost-utility analysis comparing decompression and decompression with fusion to THA and TKA, from the perspective of the provincial health insurance system, was based on an observational matched-cohort study of prospectively collected outcomes and retrospectively collected costs. Patient outcomes were measured using short-form (SF)-36 surveys over a 2-year follow-up period. Utility was modelled over the lifetime, and quality-adjusted life years (QALYs) were determined. We calculated the incremental cost per QALY gained by estimating mean incremental lifetime costs and QALYs of surgery compared with medical management of each diagnosis group after discounting costs and QALYs at 3%. Sensitivity analyses were also conducted. Results:The lifetime incremental cost:utility ratios (ICURs) discounted at 3% were $5321 per QALY for THA, $11 275 per QALY for TKA, $2307 per QALY for spinal decompression and $7153 per QALY for spinal decompression with fusion. The sensitivity analyses did not alter the ranking of the lifetime ICURs. Conclusion:In appropriately selected patients with leg-dominant symptoms secondary to focal lumbar spinal stenosis who have failed medical management, the lifetime ICUR for surgical treatment of lumbar spinal stenosis is similar to those of THA and TKA for the treatment of OA.Contexte : La demande en chirurgie de traitement de l'arthrose de la hanche et du genou a considérablement augmenté. Les interventions pour prothèse totale de hanche (PTH) et prothèse totale du genou (PTG) sont largement reconnues pour leur rapport coût:efficacité, mais les chirurgies de la colonne (décompression, décom-pression avec arthrodèse) pour le traitement des maladies dégénératives restent sousfinancées comparativement aux autres chirurgies.Méthodes : Nous avons adopté l'angle du régime d'assurance santé provincial pour effectuer une analyse comparative du rapport coût:utilité différentiel entre la décom-pression et la décompression avec arthrodèse, d'une part, et la PTH et la PTG, d'autre part, à partir des résultats regroupés de façon prospective et des coûts regroupés de façon rétrospective dans une cohorte d'observation assortie. Les résultats chez les patients ont été mesurés au moyen de questionnaires SF-36 sur une période de suivi de 2 ans. Le volet utilité a quant à lui été modélisé pour la vie durant et on a calculé le nombre d'années de vie ajustées en fonction de la qualité (AVAQ). Nous avons aussi calculé le coût différentiel par AVAQ ...

Determining Health-Related Quality-of-Life Outcomes Using the SF-6D Preference-Based Measure in Patients Following Total Knee Arthroplasty

“…For example, Tso et al [8] used SF-6D to convert physical and mental outcome data into utility scores after THA, TKA, and lumbar decompressions. They determined QALYs gained for each procedure and concluded that incremental cost:utility ratio per QALY for each cohort was $5321, $11,275, and $2307 for THA, TKA, and spinal decompression, surgery.…”

“…The short form 6D is a relatively new measurement method, and several studies have used it to derive cost-utility ratios to compare outcomes of different surgical interventions to each other as well as to medical management alone [7,8]. This score is of interest as it provides a description of health and has the capability to be used in an economic model.…”

The future of medical reimbursement for orthopedic surgery in Japan from the viewpoint of the health economy

“…Due to the wide time frame in which clinical research was conducted, the various study designs, and the case groups that were evaluated, we find that many evaluations of medical interventions, which are based on health economics principles, are being developed for aspects of orthopedic surgery that range from surgical therapy to pharmacotherapy or disease prevention [11][12][13][14][15][16][17][18][19][20][21].…”

Transforaminal lumbar interbody fusion and posterior lumbar interbody fusion utilizing BMP-2 in treatment of degenerative spondylolisthesis: neither safe nor cost effective

“…[7] For example, primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) have proven to be among the most cost-effective surgical interventions both musculoskeletal and otherwise at $8031 per QALY for THA and $18,300 per QALY for TKA. [25]…”

“…This enables the comparison of ICURs for the treatment of multiple conditions. [25] Our primary objective in this review was to assess the improved health vs. maintained-related quality of life (QALY) for those undergoing decompression with interbody fusion accompanied by bone morphogenetic protein (BMP) for spinal stenosis with degenerative spondylolisthesis (DS) vs. more routine posterolateral fusion (PLF) techniques without BMP.…”