• Peter G Passias, Jamshaid M Mir, Pooja Dave, Justin S Smith, Renaud Lafage, Jeffrey Gum, Breton G Line, Bassel Diebo, Alan H Daniels, David Kojo Hamilton, Thomas J Buell, Justin K Scheer, Robert K Eastlack, Jeffrey P Mullin, Gregory M Mundis, Naobumi Hosogane, Mitsuru Yagi, Andrew J Schoenfeld, Juan S Uribe, Neel Anand, Praveen V Mummaneni, Dean Chou, Eric O Klineberg, Khaled M Kebaish, Stephen J Lewis, Munish C Gupta, Han Jo Kim, Robert A Hart, Lawrence G Lenke, Christopher P Ames, Christopher I Shaffrey, Frank J Schwab, Virginie Lafage, Richard A Hostin, Shay Bess, Douglas C Burton, and International Spine Study Group.
• Departments of Orthopedic and Neurological Surgery, Division of Spine Surgery, NYU Langone Medical Center; New York Spine Institute, New York, NY.
• Spine. 2024 Oct 15; 49 (20): 140114091401-1409.

Study DesignRetrospective cohort.ObjectiveTo evaluate factors associated with the long-term durability of cost-effectiveness (CE) in ASD patients.BackgroundA substantial increase in costs associated with the surgical treatment for adult spinal deformity (ASD) has given precedence to scrutinize the value and utility it provides.MethodsWe included 327 operative ASD patients with five-year (5 yr) follow-up. Published methods were used to determine costs based on CMS.gov definitions and were based on the average DRG reimbursement rates. The utility was calculated using quality-adjusted life-years (QALY) utilizing the Oswestry Disability Index (ODI) converted to Short-Form Six-Dimension (SF-6D), with a 3% discount applied for its decline in life expectancy. The CE threshold of $150,000 was used for primary analysis.ResultsMajor and minor complication rates were 11% and 47%, respectively, with 26% undergoing reoperation by five years. The mean cost associated with surgery was $91,095±$47,003, with a utility gain of 0.091±0.086 at one years, QALY gained at 2 years of 0.171±0.183, and at five years of 0.42±0.43. The cost per QALY at two years was $414,885, which decreased to $142,058 at five years.With the threshold of $150,000 for CE, 19% met CE at two years and 56% at five years. In those in which revision was avoided, 87% met cumulative CE till life expectancy. Controlling analysis depicted higher baseline CCI and pelvic tilt (PT) to be the strongest predictors for not maintaining durable CE to five years [CCI OR: 1.821 (1.159-2.862), P =0.009] [PT OR: 1.079 (1.007-1.155), P =0.030].ConclusionsMost patients achieved cost-effectiveness after four years postoperatively, with 56% meeting at five years postoperatively. When revision was avoided, 87% of patients met cumulative cost-effectiveness till life expectancy. Mechanical complications were predictive of failure to achieve cost-effectiveness at two years, while comorbidity burden and medical complications were at five years.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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