The cost-effectiveness of interbody fusions versus posterolateral fusions in 137 patients with lumbar spondylolisthesis

Mohamad Bydon, Mohamed MacKi, Nicholas B. Abt, Timothy F. Witham, Jean Paul Wolinsky, Ziya L. Gokaslan, Ali Bydon, Daniel M. Sciubba

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

Background context Reimbursements for interbody fusions have declined recently because of their questionable cost-effectiveness. Purpose A Markov model was adopted to compare the cost-effectiveness of posterior lumbar interbody fusion (PLIF) or transforaminal lumbar interbody fusion (/TLIF) versus noninterbody fusion and posterolateral fusion (PLF) in patients with lumbar spondylolisthesis. Study design/Setting Decision model analysis based on retrospective data from a single institutional series. Patient sample One hundred thirty-seven patients underwent first-time instrumented lumbar fusions for degenerative or isthmic spondylolisthesis. Outcome measures Quality of life adjustments and expenditures were assigned to each short-term complication (durotomy, surgical site infection, and medical complication) and long-term outcome (bowel/bladder dysfunction and paraplegia, neurologic deficit, and chronic back pain). Methods Patients were divided into a PLF cohort and a PLF plus PLIF/TLIF cohort. Anterior techniques and multilevel interbody fusions were excluded. Each short-term complication and long-term outcome was assigned a numerical quality-adjusted life-year (QALY), based on time trade-off values in the Beaver Dam Health Outcomes Study. The cost data for short-term complications were calculated from charges accrued by the institution's finance sector, and the cost data for long-term outcomes were estimated from the literature. The difference in cost of PLF plus PLIF/TLIF from the cost of PLF alone divided by the difference in QALY equals the cost-effectiveness ratio (CER). We do not report any study funding sources or any study-specific appraisal of potential conflict of interest-associated biases in this article. Results Of 137 first-time lumbar fusions for spondylolisthesis, 83 patients underwent PLF and 54 underwent PLIF/TLIF. The average time to reoperation was 3.5 years. The mean QALY over 3.5 years was 2.81 in the PLF cohort versus 2.66 in the PLIFo/TLIF cohort (p=.110). The mean 3.5-year costs of $54,827.05 after index interbody fusion were statistically higher than that of the $48,822.76 after PLF (p=.042). The CER of interbody fusion to PLF after the first operation was -$46,699.40 per QALY; however, of the 27 patients requiring reoperation, the incident (reoperation) rate ratio was 7.89 times higher after PLF (2.91, 26.67). The CER after the first reoperation was -$24,429.04 per QALY (relative to PLF). Two patients in the PLF cohort required a second reoperation, whereas none required a second reoperation in the PLIF/TLIF cohort. Taken collectively, the total CER for the interbody fusion is $9,883.97 per QALY. Conclusions The reoperation rate was statistically higher for PLF, whereas the negative CER for the initial operation and first reoperation favors PLF. However, when second reoperations were included, the CER for the interbody fusion became $9,883.97 per QALY, suggesting moderate long-term cost savings and better functional outcomes with the interbody fusion.

Original languageEnglish (US)
Pages (from-to)492-498
Number of pages7
JournalSpine Journal
Volume15
Issue number3
DOIs
StatePublished - Mar 1 2015
Externally publishedYes

Fingerprint

Spondylolisthesis
Reoperation
Quality-Adjusted Life Years
Cost-Benefit Analysis
Costs and Cost Analysis
Outcome Assessment (Health Care)
Surgical Wound Infection
Conflict of Interest
Decision Support Techniques
Cost Savings
Paraplegia
Back Pain
Health Expenditures
Neurologic Manifestations
Chronic Pain
Rodentia
Urinary Bladder
Quality of Life

Keywords

  • Cost-effectiveness
  • Interbody
  • Lumbar
  • PLIF
  • Spondylolisthesis
  • TLIF

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Medicine(all)

Cite this

Bydon, M., MacKi, M., Abt, N. B., Witham, T. F., Wolinsky, J. P., Gokaslan, Z. L., ... Sciubba, D. M. (2015). The cost-effectiveness of interbody fusions versus posterolateral fusions in 137 patients with lumbar spondylolisthesis. Spine Journal, 15(3), 492-498. https://doi.org/10.1016/j.spinee.2014.10.007

The cost-effectiveness of interbody fusions versus posterolateral fusions in 137 patients with lumbar spondylolisthesis. / Bydon, Mohamad; MacKi, Mohamed; Abt, Nicholas B.; Witham, Timothy F.; Wolinsky, Jean Paul; Gokaslan, Ziya L.; Bydon, Ali; Sciubba, Daniel M.

In: Spine Journal, Vol. 15, No. 3, 01.03.2015, p. 492-498.

Research output: Contribution to journalArticle

Bydon, M, MacKi, M, Abt, NB, Witham, TF, Wolinsky, JP, Gokaslan, ZL, Bydon, A & Sciubba, DM 2015, 'The cost-effectiveness of interbody fusions versus posterolateral fusions in 137 patients with lumbar spondylolisthesis', Spine Journal, vol. 15, no. 3, pp. 492-498. https://doi.org/10.1016/j.spinee.2014.10.007
Bydon, Mohamad ; MacKi, Mohamed ; Abt, Nicholas B. ; Witham, Timothy F. ; Wolinsky, Jean Paul ; Gokaslan, Ziya L. ; Bydon, Ali ; Sciubba, Daniel M. / The cost-effectiveness of interbody fusions versus posterolateral fusions in 137 patients with lumbar spondylolisthesis. In: Spine Journal. 2015 ; Vol. 15, No. 3. pp. 492-498.
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abstract = "Background context Reimbursements for interbody fusions have declined recently because of their questionable cost-effectiveness. Purpose A Markov model was adopted to compare the cost-effectiveness of posterior lumbar interbody fusion (PLIF) or transforaminal lumbar interbody fusion (/TLIF) versus noninterbody fusion and posterolateral fusion (PLF) in patients with lumbar spondylolisthesis. Study design/Setting Decision model analysis based on retrospective data from a single institutional series. Patient sample One hundred thirty-seven patients underwent first-time instrumented lumbar fusions for degenerative or isthmic spondylolisthesis. Outcome measures Quality of life adjustments and expenditures were assigned to each short-term complication (durotomy, surgical site infection, and medical complication) and long-term outcome (bowel/bladder dysfunction and paraplegia, neurologic deficit, and chronic back pain). Methods Patients were divided into a PLF cohort and a PLF plus PLIF/TLIF cohort. Anterior techniques and multilevel interbody fusions were excluded. Each short-term complication and long-term outcome was assigned a numerical quality-adjusted life-year (QALY), based on time trade-off values in the Beaver Dam Health Outcomes Study. The cost data for short-term complications were calculated from charges accrued by the institution's finance sector, and the cost data for long-term outcomes were estimated from the literature. The difference in cost of PLF plus PLIF/TLIF from the cost of PLF alone divided by the difference in QALY equals the cost-effectiveness ratio (CER). We do not report any study funding sources or any study-specific appraisal of potential conflict of interest-associated biases in this article. Results Of 137 first-time lumbar fusions for spondylolisthesis, 83 patients underwent PLF and 54 underwent PLIF/TLIF. The average time to reoperation was 3.5 years. The mean QALY over 3.5 years was 2.81 in the PLF cohort versus 2.66 in the PLIFo/TLIF cohort (p=.110). The mean 3.5-year costs of $54,827.05 after index interbody fusion were statistically higher than that of the $48,822.76 after PLF (p=.042). The CER of interbody fusion to PLF after the first operation was -$46,699.40 per QALY; however, of the 27 patients requiring reoperation, the incident (reoperation) rate ratio was 7.89 times higher after PLF (2.91, 26.67). The CER after the first reoperation was -$24,429.04 per QALY (relative to PLF). Two patients in the PLF cohort required a second reoperation, whereas none required a second reoperation in the PLIF/TLIF cohort. Taken collectively, the total CER for the interbody fusion is $9,883.97 per QALY. Conclusions The reoperation rate was statistically higher for PLF, whereas the negative CER for the initial operation and first reoperation favors PLF. However, when second reoperations were included, the CER for the interbody fusion became $9,883.97 per QALY, suggesting moderate long-term cost savings and better functional outcomes with the interbody fusion.",
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T1 - The cost-effectiveness of interbody fusions versus posterolateral fusions in 137 patients with lumbar spondylolisthesis

AU - Bydon, Mohamad

AU - MacKi, Mohamed

AU - Abt, Nicholas B.

AU - Witham, Timothy F.

AU - Wolinsky, Jean Paul

AU - Gokaslan, Ziya L.

AU - Bydon, Ali

AU - Sciubba, Daniel M.

PY - 2015/3/1

Y1 - 2015/3/1

N2 - Background context Reimbursements for interbody fusions have declined recently because of their questionable cost-effectiveness. Purpose A Markov model was adopted to compare the cost-effectiveness of posterior lumbar interbody fusion (PLIF) or transforaminal lumbar interbody fusion (/TLIF) versus noninterbody fusion and posterolateral fusion (PLF) in patients with lumbar spondylolisthesis. Study design/Setting Decision model analysis based on retrospective data from a single institutional series. Patient sample One hundred thirty-seven patients underwent first-time instrumented lumbar fusions for degenerative or isthmic spondylolisthesis. Outcome measures Quality of life adjustments and expenditures were assigned to each short-term complication (durotomy, surgical site infection, and medical complication) and long-term outcome (bowel/bladder dysfunction and paraplegia, neurologic deficit, and chronic back pain). Methods Patients were divided into a PLF cohort and a PLF plus PLIF/TLIF cohort. Anterior techniques and multilevel interbody fusions were excluded. Each short-term complication and long-term outcome was assigned a numerical quality-adjusted life-year (QALY), based on time trade-off values in the Beaver Dam Health Outcomes Study. The cost data for short-term complications were calculated from charges accrued by the institution's finance sector, and the cost data for long-term outcomes were estimated from the literature. The difference in cost of PLF plus PLIF/TLIF from the cost of PLF alone divided by the difference in QALY equals the cost-effectiveness ratio (CER). We do not report any study funding sources or any study-specific appraisal of potential conflict of interest-associated biases in this article. Results Of 137 first-time lumbar fusions for spondylolisthesis, 83 patients underwent PLF and 54 underwent PLIF/TLIF. The average time to reoperation was 3.5 years. The mean QALY over 3.5 years was 2.81 in the PLF cohort versus 2.66 in the PLIFo/TLIF cohort (p=.110). The mean 3.5-year costs of $54,827.05 after index interbody fusion were statistically higher than that of the $48,822.76 after PLF (p=.042). The CER of interbody fusion to PLF after the first operation was -$46,699.40 per QALY; however, of the 27 patients requiring reoperation, the incident (reoperation) rate ratio was 7.89 times higher after PLF (2.91, 26.67). The CER after the first reoperation was -$24,429.04 per QALY (relative to PLF). Two patients in the PLF cohort required a second reoperation, whereas none required a second reoperation in the PLIF/TLIF cohort. Taken collectively, the total CER for the interbody fusion is $9,883.97 per QALY. Conclusions The reoperation rate was statistically higher for PLF, whereas the negative CER for the initial operation and first reoperation favors PLF. However, when second reoperations were included, the CER for the interbody fusion became $9,883.97 per QALY, suggesting moderate long-term cost savings and better functional outcomes with the interbody fusion.

AB - Background context Reimbursements for interbody fusions have declined recently because of their questionable cost-effectiveness. Purpose A Markov model was adopted to compare the cost-effectiveness of posterior lumbar interbody fusion (PLIF) or transforaminal lumbar interbody fusion (/TLIF) versus noninterbody fusion and posterolateral fusion (PLF) in patients with lumbar spondylolisthesis. Study design/Setting Decision model analysis based on retrospective data from a single institutional series. Patient sample One hundred thirty-seven patients underwent first-time instrumented lumbar fusions for degenerative or isthmic spondylolisthesis. Outcome measures Quality of life adjustments and expenditures were assigned to each short-term complication (durotomy, surgical site infection, and medical complication) and long-term outcome (bowel/bladder dysfunction and paraplegia, neurologic deficit, and chronic back pain). Methods Patients were divided into a PLF cohort and a PLF plus PLIF/TLIF cohort. Anterior techniques and multilevel interbody fusions were excluded. Each short-term complication and long-term outcome was assigned a numerical quality-adjusted life-year (QALY), based on time trade-off values in the Beaver Dam Health Outcomes Study. The cost data for short-term complications were calculated from charges accrued by the institution's finance sector, and the cost data for long-term outcomes were estimated from the literature. The difference in cost of PLF plus PLIF/TLIF from the cost of PLF alone divided by the difference in QALY equals the cost-effectiveness ratio (CER). We do not report any study funding sources or any study-specific appraisal of potential conflict of interest-associated biases in this article. Results Of 137 first-time lumbar fusions for spondylolisthesis, 83 patients underwent PLF and 54 underwent PLIF/TLIF. The average time to reoperation was 3.5 years. The mean QALY over 3.5 years was 2.81 in the PLF cohort versus 2.66 in the PLIFo/TLIF cohort (p=.110). The mean 3.5-year costs of $54,827.05 after index interbody fusion were statistically higher than that of the $48,822.76 after PLF (p=.042). The CER of interbody fusion to PLF after the first operation was -$46,699.40 per QALY; however, of the 27 patients requiring reoperation, the incident (reoperation) rate ratio was 7.89 times higher after PLF (2.91, 26.67). The CER after the first reoperation was -$24,429.04 per QALY (relative to PLF). Two patients in the PLF cohort required a second reoperation, whereas none required a second reoperation in the PLIF/TLIF cohort. Taken collectively, the total CER for the interbody fusion is $9,883.97 per QALY. Conclusions The reoperation rate was statistically higher for PLF, whereas the negative CER for the initial operation and first reoperation favors PLF. However, when second reoperations were included, the CER for the interbody fusion became $9,883.97 per QALY, suggesting moderate long-term cost savings and better functional outcomes with the interbody fusion.

KW - Cost-effectiveness

KW - Interbody

KW - Lumbar

KW - PLIF

KW - Spondylolisthesis

KW - TLIF

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