• Anna N A Tosteson, Jon D Lurie, Tor D Tosteson, Jonathan S Skinner, Harry Herkowitz, Todd Albert, Scott D Boden, Keith Bridwell, Michael Longley, Gunnar B Andersson, Emily A Blood, Margaret R Grove, James N Weinstein, and SPORT Investigators.
• Multidisciplinary Clinical Research Center in Musculoskeletal Diseases, Dartmouth Medical School, Hanover, New Hampshire 03756, USA.
• Ann. Intern. Med. 2008 Dec 16;149(12):845-53.

BackgroundThe SPORT (Spine Patient Outcomes Research Trial) reported favorable surgery outcomes over 2 years among patients with stenosis with and without degenerative spondylolisthesis, but the economic value of these surgeries is uncertain.ObjectiveTo assess the short-term cost-effectiveness of spine surgery relative to nonoperative care for stenosis alone and for stenosis with spondylolisthesis.DesignProspective cohort study.Data SourcesResource utilization, productivity, and EuroQol EQ-5D score measured at 6 weeks and at 3, 6, 12, and 24 months after treatment among SPORT participants.Target PopulationPatients with image-confirmed spinal stenosis, with and without degenerative spondylolisthesis.Time Horizon2 years.PerspectiveSocietal.InterventionNonoperative care or surgery (primarily decompressive laminectomy for stenosis and decompressive laminectomy with fusion for stenosis associated with degenerative spondylolisthesis).Outcome MeasuresCost per quality-adjusted life-year (QALY) gained.Results Of Base Case AnalysisAmong 634 patients with stenosis, 394 (62%) had surgery, most often decompressive laminectomy (320 of 394 [81%]). Stenosis surgeries improved health to a greater extent than nonoperative care (QALY gain, 0.17 [95% CI, 0.12 to 0.22]) at a cost of $77,600 (CI, $49,600 to $120,000) per QALY gained. Among 601 patients with degenerative spondylolisthesis, 368 (61%) had surgery, most including fusion (344 of 368 [93%]) and most with instrumentation (269 of 344 [78%]). Degenerative spondylolisthesis surgeries significantly improved health versus nonoperative care (QALY gain, 0.23 [CI, 0.19 to 0.27]), at a cost of $115,600 (CI, $90,800 to $144,900) per QALY gained. RESULT OF SENSITIVITY ANALYSIS: Surgery cost markedly affected the value of surgery.LimitationThe study used self-reported utilization data, 2-year time horizon, and as-treated analysis to address treatment nonadherence among randomly assigned participants.ConclusionThe economic value of spinal stenosis surgery at 2 years compares favorably with many health interventions. Degenerative spondylolisthesis surgery is not highly cost-effective over 2 years but could show value over a longer time horizon.

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