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- Title
Quality of life and cost-utility of surgical treatment for patients with spinal metastases: prospective cohort study.
- Authors
Miyazaki, Shingo; Kakutani, Kenichiro; Sakai, Yoshitada; Ejima, Yasuo; Maeno, Koichiro; Takada, Toru; Yurube, Takashi; Terashima, Yoshiki; Ito, Masaaki; Kakiuchi, Yuji; Takeoka, Yoshiki; Hara, Hitomi; Kawamoto, Teruya; Sakashita, Akihiro; Okada, Takuya; Kiyota, Naomi; Kizawa, Yoshiyuki; Sasaki, Ryohei; Akisue, Toshihiro; Minami, Hironobu
- Abstract
<bold>Purpose: </bold>Palliative surgery for patients with spinal metastasis provides good clinical outcomes. However, there have been few studies on quality of life (QOL) and cost-utility of this surgery. We aimed to elucidate QOL and cost-utility of surgical treatment for spinal metastasis.<bold>Methods: </bold>We prospectively analyzed 47 patients with spinal metastasis from 2010 to 2014 who had a surgical indication. Thirty-one patients who desired surgery underwent spinal surgery (surgery group). Sixteen patients who did not want to undergo spinal surgery (non-surgery group). The EuroQol 5D (EQ-5D) and relevant costs were measured at one, three, six, and 12 months after study enrollment. Health state values were obtained by Japanese EQ-5D scoring and quality-adjusted life years (QALY) gained were calculated for each group. Cost-utility was expressed as the incremental cost-utility ratio (ICUR).<bold>Results: </bold>Health state values improved from 0.036 at study enrollment to 0.448 at 12 months in the surgery group, but deteriorated from 0.056 to 0.019 in the non-surgery group, with a significant difference between groups (P < 0.05). The mean QALY gained at 12 months were 0.433 in the surgery group and 0.024 in the non-surgery group. The mean total cost per patient in the surgery group was $25,770 compared with $8615 in the non-surgery group. The ICUR using oneyear follow-up data was $42,003/QALY gained.<bold>Conclusions: </bold>Surgical treatment for spinal metastases is associated with significant improvement in health state value. In orthopaedic surgery, an ICUR less than $50,000/QALY gained is considered acceptable cost-effectiveness. Our results indicate that surgical treatment could be cost-effective.
- Subjects
PALLIATIVE treatment; PATIENTS; QUALITY of life; METASTASIS; SPINAL surgery; COST effectiveness; LONGITUDINAL method; NEUROSURGERY; QUESTIONNAIRES; SPINAL tumors; QUALITY-adjusted life years
- Publication
International Orthopaedics, 2017, Vol 41, Issue 6, p1265
- ISSN
0341-2695
- Publication type
journal article
- DOI
10.1007/s00264-017-3463-9