Cost-Utility Analysis Compared Between Radiotherapy Alone and Combined Surgery and Radiotherapy for Symptomatic Spinal Metastases in Thailand

Abstract

Objective: To investigate the patient quality of life and cost-utility compared between radiotherapy alone and combined surgery and radiotherapy for spinal metastasis (SM) in Thailand.Methods: Patients with SM with an indication for surgery during 2018–2020 were prospectively recruited. Patients were assigned to either the combination surgery and radiotherapy group or the radiotherapy alone group. Quality of life was assessed by EuroQol-5D-5L (EQ-5D-5L) questionnaire, and relevant healthcare costs were collected pretreatment, and at 3-month and 6-month posttreatment. Total lifetime cost and quality-adjusted life-years (QALYs) were estimated for each group.Results: Twenty-four SM patients (18 females, 6 males) were included. Of those, 12 patients underwent combination treatment, and 12 underwent radiotherapy alone. At 6-month posttreatment, 10 patients in the surgery group, and 11 patients in the nonsurgery group remained alive for a survival rate of 83.3% and 91.7%, retrospectively. At 6-month posttreatment, the mean utility in the combination treatment group was significantly better than in the radiotherapy alone group (0.804 ± 0.264 vs. 0.518 ± 0.282, respectively; p = 0.011). Total lifetime costs were 59,863.14 United States dollar (USD) in the combination treatment group and 24,526.97 USD in the radiation-only group. The incremental cost-effectiveness ratio using 6-month follow-up data was 57,074.01 USD per QALY gained.Conclusion: Surgical treatment combined with radiotherapy to treat SM significantly improved patient quality of life compared to radiotherapy alone during the 6-month posttreatment period. However, combination treatment was found not to be cost-effective compared to radiotherapy alone for SM at the Thailand willingness-to-pay threshold of 5,113 USD/QALY.

Carbon Fiber-Reinforced Polyetheretherketone Spinal Implants for Treatment of Spinal Tumors: Perceived Advantages and Limitations

“…Radiation therapy is frequently used to treat spinal metastases and primary tumors either alone or combined with surgery. 2,8,18,19 Dose calculation can be impaired if the planning images are excessively distorted due to metallic artifacts. 9 As a result, CT myelogram following implantation of titanium hardware is typically performed for identification of the spinal cord and cauda equina for SSRS contouring.…”

The Role and Clinical Outcomes of Endoscopic Spine Surgery of Treating Spinal Metastases; Outcomes of 29 Cases From 8 Countries

“…Although most are asymptomatic, symptomatic spinal metastases can severely affect the patient’s quality of life by causing excruciating pain, neurological deficit, and deteriorating ambulation status [ 2 , 3 ]. The mainstay of treatment consists of palliative radiation and spine surgery in appropriately selected patients [ 4 , 5 ]. However, considering the natural history of cancer disease and the patient’s deteriorating frailty status, higher complication rates and more surgical stress is suspected in this population compared to other spinal disorders [ 6 ].…”

“…2,3 The mainstay of treatment consists of palliative radiation and spine surgery in appropriately selected patients. 4,5 However, considering the natural history of cancer disease and the patient's deteriorating frailty status, higher complication rates and more surgical stress is suspected in this population compared to other spinal disorders. 6 Recently, minimally invasive spine surgery (MISS) has been implemented.…”