431 - Effectiveness and Cost per Quality Adjusted Life Year (QALY) Gained fr...

#431 Effectiveness and Cost per Quality Adjusted Life Year (QALY) Gained from Comprehensive Medical Management of Lumbar Spondylosis

General Session: Best Papers Session 2

Presented by: S. Parker

Author(s):

S.L. Parker (1)
S. Godil (1)
S. Mendenhall (1)
S. Zuckerman (1)
D. Shau (1)
M.J. McGirt (1)

(1) Vanderbilt University Medical Center, Neurological Surgery, Nashville, TN, USA

Abstract

Background: The effectiveness and relative value (cost/improvement) of medical management in patients with lumbar spondylolisthesis or stenosis remains debated and poorly understood. We assessed the effectiveness and associated cost per quality adjusted life year (QALY) gained of comprehensive medical management for lumbar spondylolisthesis or stenosis utilizing a prospective single-center multidisciplinary spine center registry in a real-world practice setting.

Methods: Seventy-five patients with lumbar spondylolisthesis or stenosis managed at a single institution's Multidisciplinary Spine Center were entered into a prospective registry. Comprehensive medical management included spinal steroid injections, physical therapy, oral medications, and various other therapies. Baseline and two-year patient-reported outcomes (PRO) were assessed. Two-year PROs, back-related medical resource utilization, and work-day losses were prospectively assessed via phone interview and used to calculate Medicare fee-based direct cost and indirect costs from occupation loss.

Results: Baseline characteristics provided in Table 1. Comprehensive medical management resulted in only modest improvement in PROs assessed, Figure 1. Statistically significant improvements were seen in only BP-VAS (p=0.01) and ODI (p=0.04); however, neither of these improvements reached previously reported thresholds for a minimum clinically important difference (MCID). Notably, there was no significant improvement in quality of life (p=0.10), as EQ-5D improved by only 0.08 QALYs. Mean total two-year cost of comprehensive medical management was $9,013, Table 2. Two-year cost per QALY gained for medical management of lumbar spondylolisthesis or stenosis was $112,663.

Conclusions: Comprehensive medical management of lumbar spondylolisthesis or stenosis resulted in only minor to no improvement in the patient-reported outcome metrics assessed. While the mean overall (direct + indirect) two-year cost of medical management was relatively low ($9,013), the associated improvement in EQ-5D was also quite small (0.08 QALYs). This results in a cost/QALY gain of $112,663, and suggests that the real-world value (cost/effect) of comprehensive medical management for lumbar spondylolisthesis or stenosis may not be as high as previously demonstrated in randomized, controlled trials such as SPORT.

Tables 1 and 2

Figure 1