Cost-utility Analysis of Neoadjuvant Teriparatide Therapy in Osteopenic Patients Undergoing Adult Spinal Deformity Surgery

Abstract

Study Design. A cost-utility analysis study. Objective. This study aims to evaluate the cost-utility of neoadjuvant teriparatide therapy in osteopenic patients undergoing adult spinal deformity (ASD) surgery. Summary of Background Data. There is increasing evidence supporting preoperative use of anabolic agents such as teriparatide for preoperative optimization of ASD patients with poor bone density. However, such treatments are associated with added costs. To our knowledge, the cost-utility of teriparatide in osteopenic patients undergoing ASD surgery has not been established. Materials and Methods. A decision-analysis model was developed for a hypothetical 68-year-old female patient with osteopenia (T score <−1.0) undergoing a T11 to pelvis instrumented spinal fusion for ASD. A comprehensive literature review was conducted to create estimates for event probabilities, costs, and quality adjusted life years at each node. Key model assumptions were that administration of a 4-month preoperative teriparatide course reduced 2-year postoperative reoperation rates [for pseudarthrosis from 5% to 2.5% and for proximal junctional failure (PJF) from 15% to 5%]. Monte Carlo simulations were used to calculate the mean incremental cost utility ratio and incremental net monetary benefits. One-way sensitivity analysis was used to estimate the contribution of individual parameters to uncertainty in the model. Results. Teriparatide was the favored strategy in 82% of the iterations. The mean incremental cost utility ratio for the teriparatide strategy was negative (higher net benefit, lower net cost), and lower than the willingness-to-pay threshold of $50,000 per quality adjusted life year. Teriparatide use was associated with a mean incremental net monetary benefit of $3,948. One-way sensitivity analysis demonstrated that the factors with the greatest impact on the model were the incidence of PJF in the no teriparatide group, the duration and monthly cost of treatment, and the cost of reoperation due to PJF. Conclusions. Neoadjuvant teriparatide is a cost-effective strategy to reduce postoperative complications in patients with osteopenia undergoing ASD surgery.

Assessing the influence of modifiable patient-related factors on complication rates after adult spinal deformity surgery

“…Preoperative interventions for smoking cessation, weight loss, depression, diabetes management, blood pressure control, and osteoporosis have all shown benefits in terms of minimizing complication rates and maximizing clinical improvement after spinal surgery. 27,43,44 Raad et al 44 found that four-month preoperative intervention of teriparatide in osteopenic patients was both clinically effective and cost-effective, mitigating the occurrence of pseudarthrosis and PJF. Our results build on this previous literature by helping clinicians prioritize those factors that may be of greatest import in the perioperative period and those which might preclude surgical intervention until properly addressed.…”

Bone Quality in Spinal Surgery: Evaluation, Implications, and Treatments

“…5 It has also been demonstrated that treatment with teriparatide analogs may reduce PJK rates from 15.2% to 4.6% in adult spinal deformity patients. 6 It is worth noting that despite the substantial costs of some of these treatments, they have been demonstrated to be cost-effective in 82% of patients with osteopenia, according to a study by Raad et al 7…”

Survey on Actual Management of Osteoporosis with the Japanese Medical Data Vision Database in Elderly Patients Undergoing Spinal Fusion

“…Firstly, there is a substantial body of evidence in Japan demonstrating the beneficial effects of TPTD in patients with osteoporosis who undergo spinal fusion surgery [41][42][43][44][45]. Additionally, neoadjuvant TPTD has been reported to be a cost-effective strategy for reducing post-operative complications in patients with osteopenia undergoing adjacent segment degeneration surgery [47]. Secondly, Japan has a comprehensive healthcare insurance system, the National Health Insurance system.…”