General Session: Value and Outcomes in Spine Surgery - Hall F
Presented by: M. Pahuta
M. Pahuta(1), J. Werier(2), E. Wai(2), D. Coyle(3)
(1) Henry for Health System, Orthopedic and Neurological Surgery, Detroit, MI, United States
(2) The Ottawa Hospital, Ottawa, ON, Canada
(3) University of Ottawa, Ottawa, ON, Canada
Objectives: A particularly disabling consequence of cancer is metastatic epidural spinal cord compression (MESCC). Few prospective studies on the treatment of MESCC have collected quality-adjusted-life-year weights (termed "utilities"). Utilities are an important summative measure which distills health outcomes to a single number that can be used by healthcare providers to counsel patients and policy makers to make funding decisions. The primary objective of this study is to obtain utility valuations for the 31 unique MESCC health states from a Canadian general population perspective. The secondary objective of this study is to determine the relative importance of various aspects to quality-of-life in MESCC.
Method: We recruited a sample of 822 adult Canadians from a market research company. Quota sampling was used to ensure that the participants were representative of the Canadian population in terms of age, gender, and province of residence. Participants were asked to rate 6 of the 31 MESCC health states using the validated SOAP tool.
Results: Sixty-six percent of participants provided logical ratings (for example perfect health was rated higher than non-ambulatory health states). The regression model building exercise revealed that members of the general population value all attributes characterizing MESCC health states equally. Furthermore, dysfunction follows a pattern of diminishing marginal disutility). That is, each additional dysfunction affects a smaller incremental change in utility than the previous dysfunction. These results demonstrate that from the societal perspective, physical function is valued equal to other facets of well-being. Ambulation and continence, which are dysfunctions addressed by surgery, are no more important than other attributes evaluated (pain, other symptoms, and level of independence).
Conclusions: We have provided utility estimates for metastatic epidural spinal cord compression health states. The utility values derived from this study can be used to help inform population level healthcare decision making, such as allocation of limited resources for specific treatments. Approximately 63.7% of participants completed, understood and engaged in the task. Thus self-administered utility valuation over the internet is feasible. This approach can serve as a model for deriving utilities for conditions for which quality-of-life data is not available.