Operative Management of Adult Spinal Deformity Results in Significant Increases in QALYs Gained Compared to Nonoperative Management

Justin K. Scheer, Richard Hostin, Chessie Robinson, Frank Schwab, Virginie Lafage, Douglas C. Burton, Robert Hart, Michael P. Kelly, Malla Keefe, David Polly, Shay Bess, Christopher I. Shaffrey, Justin S. Smith, Christopher P. Ames

Research output: Contribution to journalArticle

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Abstract

Study Design. Retrospective review of prospective multicenter adult spinal deformity (ASD) database. Objective. To compare the quality-adjusted life years (QALYs) between operative and nonoperative treatments for ASD patients. Summary of Background Data. Operative management of ASD repeatedly demonstrates improvements in HRQOL over nonoperative treatment. However, little is reported regarding QALY improvements after surgical correction of ASD. Methods. Inclusion criteria: ≥18 years, ASD. Health utility values were calculated from SF6D scores and used to calculate QALYs at minimum 2 years from the baseline utility value as well as at 1, 2, and 3 years for the available patients. A 1:1 propensity score matching using six baseline variables was conducted to account for the nonrandom distribution of operative and nonoperative treatments. Results. Four hundred seventy-nine patients were included (OP:258, 70.7%, NONOP:221, 47.1%). One hundred fifty-one (OP:90, NONOP:61) had complete 1, 2, and 3 year data available for QALY trending. Unmatched results are not listed in the abstract. Mean baseline utility scores were statistically similar between the matched groups (OP: 0.609 ± 0.093, NONOP: 0.600 ± 0.091, P = 0.6401) and at 2 year min postop mean OP QALY was greater than NONOP (1.377 ± 0.345 vs. 1.256 ± 0.286, respectively, P < 0.01). For the subanalysis cohort, mean OP QALYs at 1, 2, and 3 years postoperative were all significantly greater than NONOP, P < 0.03 for all (1 yr: 0.651 ± 0.089 vs. 0.61 ± 0.079, 2 yr: 1.29 ± 0.157 vs. 1.189 ± 0.141, and 3 yr: 1.903 ± 0.235 vs. 1.749 ± 0.198, respectively). Matched OP had a larger QALYs gained (from baseline) at 2 year minimum postoperative (0.112 ± 0.243 vs. 0.008 ± 0.195, P < 0.01). For subanalysis of patients with complete 1 to 3 years data, OP had a significantly larger QALYs gained at 1, 2, and 3 years compared with NONOP: 1 year (0.073 ± 0.121 vs. 0.029 ± 0.082, P = 0.0447), 2 years (0.167 ± 0.232 vs. 0.036 ± 0.173, P = 0.0030), and 3years (0.238 ± 0.379 vs. 0.059 ± 0.258, P < 0.01). Conclusion. The operative treatment of adult spinal deformity results in significantly greater mean QALYs and QALYs gained at minimum 2 years postop as well as at the 1-, 2-, and 3-year time points compared with nonoperative management. Level of Evidence: 3

Original languageEnglish (US)
Pages (from-to)339-347
Number of pages9
JournalSpine
Volume43
Issue number5
DOIs
StatePublished - Mar 1 2018

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Quality-Adjusted Life Years
Propensity Score
Therapeutics
Research Design
Quality of Life
Databases

Keywords

  • adult spinal deformity
  • ASD
  • nonoperative treatment
  • QALY
  • quality-adjusted life-year

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

Scheer, J. K., Hostin, R., Robinson, C., Schwab, F., Lafage, V., Burton, D. C., ... Ames, C. P. (2018). Operative Management of Adult Spinal Deformity Results in Significant Increases in QALYs Gained Compared to Nonoperative Management. Spine, 43(5), 339-347. https://doi.org/10.1097/BRS.0000000000001626

Operative Management of Adult Spinal Deformity Results in Significant Increases in QALYs Gained Compared to Nonoperative Management. / Scheer, Justin K.; Hostin, Richard; Robinson, Chessie; Schwab, Frank; Lafage, Virginie; Burton, Douglas C.; Hart, Robert; Kelly, Michael P.; Keefe, Malla; Polly, David; Bess, Shay; Shaffrey, Christopher I.; Smith, Justin S.; Ames, Christopher P.

In: Spine, Vol. 43, No. 5, 01.03.2018, p. 339-347.

Research output: Contribution to journalArticle

Scheer, JK, Hostin, R, Robinson, C, Schwab, F, Lafage, V, Burton, DC, Hart, R, Kelly, MP, Keefe, M, Polly, D, Bess, S, Shaffrey, CI, Smith, JS & Ames, CP 2018, 'Operative Management of Adult Spinal Deformity Results in Significant Increases in QALYs Gained Compared to Nonoperative Management', Spine, vol. 43, no. 5, pp. 339-347. https://doi.org/10.1097/BRS.0000000000001626
Scheer, Justin K. ; Hostin, Richard ; Robinson, Chessie ; Schwab, Frank ; Lafage, Virginie ; Burton, Douglas C. ; Hart, Robert ; Kelly, Michael P. ; Keefe, Malla ; Polly, David ; Bess, Shay ; Shaffrey, Christopher I. ; Smith, Justin S. ; Ames, Christopher P. / Operative Management of Adult Spinal Deformity Results in Significant Increases in QALYs Gained Compared to Nonoperative Management. In: Spine. 2018 ; Vol. 43, No. 5. pp. 339-347.
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abstract = "Study Design. Retrospective review of prospective multicenter adult spinal deformity (ASD) database. Objective. To compare the quality-adjusted life years (QALYs) between operative and nonoperative treatments for ASD patients. Summary of Background Data. Operative management of ASD repeatedly demonstrates improvements in HRQOL over nonoperative treatment. However, little is reported regarding QALY improvements after surgical correction of ASD. Methods. Inclusion criteria: ≥18 years, ASD. Health utility values were calculated from SF6D scores and used to calculate QALYs at minimum 2 years from the baseline utility value as well as at 1, 2, and 3 years for the available patients. A 1:1 propensity score matching using six baseline variables was conducted to account for the nonrandom distribution of operative and nonoperative treatments. Results. Four hundred seventy-nine patients were included (OP:258, 70.7{\%}, NONOP:221, 47.1{\%}). One hundred fifty-one (OP:90, NONOP:61) had complete 1, 2, and 3 year data available for QALY trending. Unmatched results are not listed in the abstract. Mean baseline utility scores were statistically similar between the matched groups (OP: 0.609 ± 0.093, NONOP: 0.600 ± 0.091, P = 0.6401) and at 2 year min postop mean OP QALY was greater than NONOP (1.377 ± 0.345 vs. 1.256 ± 0.286, respectively, P < 0.01). For the subanalysis cohort, mean OP QALYs at 1, 2, and 3 years postoperative were all significantly greater than NONOP, P < 0.03 for all (1 yr: 0.651 ± 0.089 vs. 0.61 ± 0.079, 2 yr: 1.29 ± 0.157 vs. 1.189 ± 0.141, and 3 yr: 1.903 ± 0.235 vs. 1.749 ± 0.198, respectively). Matched OP had a larger QALYs gained (from baseline) at 2 year minimum postoperative (0.112 ± 0.243 vs. 0.008 ± 0.195, P < 0.01). For subanalysis of patients with complete 1 to 3 years data, OP had a significantly larger QALYs gained at 1, 2, and 3 years compared with NONOP: 1 year (0.073 ± 0.121 vs. 0.029 ± 0.082, P = 0.0447), 2 years (0.167 ± 0.232 vs. 0.036 ± 0.173, P = 0.0030), and 3years (0.238 ± 0.379 vs. 0.059 ± 0.258, P < 0.01). Conclusion. The operative treatment of adult spinal deformity results in significantly greater mean QALYs and QALYs gained at minimum 2 years postop as well as at the 1-, 2-, and 3-year time points compared with nonoperative management. Level of Evidence: 3",
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author = "Scheer, {Justin K.} and Richard Hostin and Chessie Robinson and Frank Schwab and Virginie Lafage and Burton, {Douglas C.} and Robert Hart and Kelly, {Michael P.} and Malla Keefe and David Polly and Shay Bess and Shaffrey, {Christopher I.} and Smith, {Justin S.} and Ames, {Christopher P.}",
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TY - JOUR

T1 - Operative Management of Adult Spinal Deformity Results in Significant Increases in QALYs Gained Compared to Nonoperative Management

AU - Scheer, Justin K.

AU - Hostin, Richard

AU - Robinson, Chessie

AU - Schwab, Frank

AU - Lafage, Virginie

AU - Burton, Douglas C.

AU - Hart, Robert

AU - Kelly, Michael P.

AU - Keefe, Malla

AU - Polly, David

AU - Bess, Shay

AU - Shaffrey, Christopher I.

AU - Smith, Justin S.

AU - Ames, Christopher P.

PY - 2018/3/1

Y1 - 2018/3/1

N2 - Study Design. Retrospective review of prospective multicenter adult spinal deformity (ASD) database. Objective. To compare the quality-adjusted life years (QALYs) between operative and nonoperative treatments for ASD patients. Summary of Background Data. Operative management of ASD repeatedly demonstrates improvements in HRQOL over nonoperative treatment. However, little is reported regarding QALY improvements after surgical correction of ASD. Methods. Inclusion criteria: ≥18 years, ASD. Health utility values were calculated from SF6D scores and used to calculate QALYs at minimum 2 years from the baseline utility value as well as at 1, 2, and 3 years for the available patients. A 1:1 propensity score matching using six baseline variables was conducted to account for the nonrandom distribution of operative and nonoperative treatments. Results. Four hundred seventy-nine patients were included (OP:258, 70.7%, NONOP:221, 47.1%). One hundred fifty-one (OP:90, NONOP:61) had complete 1, 2, and 3 year data available for QALY trending. Unmatched results are not listed in the abstract. Mean baseline utility scores were statistically similar between the matched groups (OP: 0.609 ± 0.093, NONOP: 0.600 ± 0.091, P = 0.6401) and at 2 year min postop mean OP QALY was greater than NONOP (1.377 ± 0.345 vs. 1.256 ± 0.286, respectively, P < 0.01). For the subanalysis cohort, mean OP QALYs at 1, 2, and 3 years postoperative were all significantly greater than NONOP, P < 0.03 for all (1 yr: 0.651 ± 0.089 vs. 0.61 ± 0.079, 2 yr: 1.29 ± 0.157 vs. 1.189 ± 0.141, and 3 yr: 1.903 ± 0.235 vs. 1.749 ± 0.198, respectively). Matched OP had a larger QALYs gained (from baseline) at 2 year minimum postoperative (0.112 ± 0.243 vs. 0.008 ± 0.195, P < 0.01). For subanalysis of patients with complete 1 to 3 years data, OP had a significantly larger QALYs gained at 1, 2, and 3 years compared with NONOP: 1 year (0.073 ± 0.121 vs. 0.029 ± 0.082, P = 0.0447), 2 years (0.167 ± 0.232 vs. 0.036 ± 0.173, P = 0.0030), and 3years (0.238 ± 0.379 vs. 0.059 ± 0.258, P < 0.01). Conclusion. The operative treatment of adult spinal deformity results in significantly greater mean QALYs and QALYs gained at minimum 2 years postop as well as at the 1-, 2-, and 3-year time points compared with nonoperative management. Level of Evidence: 3

AB - Study Design. Retrospective review of prospective multicenter adult spinal deformity (ASD) database. Objective. To compare the quality-adjusted life years (QALYs) between operative and nonoperative treatments for ASD patients. Summary of Background Data. Operative management of ASD repeatedly demonstrates improvements in HRQOL over nonoperative treatment. However, little is reported regarding QALY improvements after surgical correction of ASD. Methods. Inclusion criteria: ≥18 years, ASD. Health utility values were calculated from SF6D scores and used to calculate QALYs at minimum 2 years from the baseline utility value as well as at 1, 2, and 3 years for the available patients. A 1:1 propensity score matching using six baseline variables was conducted to account for the nonrandom distribution of operative and nonoperative treatments. Results. Four hundred seventy-nine patients were included (OP:258, 70.7%, NONOP:221, 47.1%). One hundred fifty-one (OP:90, NONOP:61) had complete 1, 2, and 3 year data available for QALY trending. Unmatched results are not listed in the abstract. Mean baseline utility scores were statistically similar between the matched groups (OP: 0.609 ± 0.093, NONOP: 0.600 ± 0.091, P = 0.6401) and at 2 year min postop mean OP QALY was greater than NONOP (1.377 ± 0.345 vs. 1.256 ± 0.286, respectively, P < 0.01). For the subanalysis cohort, mean OP QALYs at 1, 2, and 3 years postoperative were all significantly greater than NONOP, P < 0.03 for all (1 yr: 0.651 ± 0.089 vs. 0.61 ± 0.079, 2 yr: 1.29 ± 0.157 vs. 1.189 ± 0.141, and 3 yr: 1.903 ± 0.235 vs. 1.749 ± 0.198, respectively). Matched OP had a larger QALYs gained (from baseline) at 2 year minimum postoperative (0.112 ± 0.243 vs. 0.008 ± 0.195, P < 0.01). For subanalysis of patients with complete 1 to 3 years data, OP had a significantly larger QALYs gained at 1, 2, and 3 years compared with NONOP: 1 year (0.073 ± 0.121 vs. 0.029 ± 0.082, P = 0.0447), 2 years (0.167 ± 0.232 vs. 0.036 ± 0.173, P = 0.0030), and 3years (0.238 ± 0.379 vs. 0.059 ± 0.258, P < 0.01). Conclusion. The operative treatment of adult spinal deformity results in significantly greater mean QALYs and QALYs gained at minimum 2 years postop as well as at the 1-, 2-, and 3-year time points compared with nonoperative management. Level of Evidence: 3

KW - adult spinal deformity

KW - ASD

KW - nonoperative treatment

KW - QALY

KW - quality-adjusted life-year

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