Surgery and Radiotherapy for Symptomatic Spinal Metastases Is More Cost Effective Than Radiotherapy Alone: A Cost Utility Analysis in a U.K. Spinal Center

Abstract

Our results demonstrate that reimbursement to hospitals for surgical management of symptomatic spinal metastases in the United Kingdom is broadly in line with costs, and that there was an overall saving as a result of community care costs being mitigated by patients walking for longer, which is within the expected National Health Service threshold. Surgery for metastatic spinal tumors is effective and a good value for the money.

Cost-Utility Analysis of Surgery and Radiotherapy for Symptomatic Spinal Metastases in a Belgian Specialist Center

“…Quality adjusted life years (QALYs) for surgical patients were generated by calculating the area under the curve when directly connecting health utility scores over time, including discounting at 3.5% a year, as described previously. 12,18 QALY calculation for the non-surgical group was modelled on the surgical group. Survival was reduced to 79% based on the study by Patchell et al 2 Health utility was modelled as staying at the pre-operative level, as it is assumed immediate improvement in status is related to surgery, then declining linearly until point of death once the matched surgical patient's health status started to decline.…”

“…Two sensitivity analyses representing an initial over-and underestimation of QALYs were completed to make the analysis more robust, as described previously. 12…”

“…Ideally, both match as far as possible, but in practice these costs may diverge. 12 Furthermore, in assessing costs, patient-level data are more reliable and robust than calculations based on national averages, given the varied presentation, disease load, response to systemic treatment and outcome in this patient group. This explains the variability in costs for surgery and/or radiotherapy, with a standard deviation equalling 48% of the average cost and an IQR stretching over almost 50% of the median cost.…”

“…Therefore, their health status was modelled on that of the surgical group, based on the Patchell outcome data.² The latter method was also applied by Turner et al in the UK cost-utility study. 12 However, in addition to the UK study, the non-surgical patients in the present analysis were not a modelled cohort, but real patients with real patient-level costs.…”

“…Turner et al found that over a lifetime horizon the mean incremental cost was £12,839 cheaper for the surgical group, but with a large standard deviation of £37,896 and a median incremental cost difference that was slightly more expensive for the surgical group. 12 hospital cost data. 13 Finally, Miyazaki et al found an ICER of US$42,003 per QALY in a prospective patient-level study in Kobe, Japan.…”