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01-03-2018 | Original Article

A cost-effectiveness comparisons of adult spinal deformity surgery in the United States and Japan

Authors: Mitsuru Yagi, Christopher P. Ames, Malla Keefe, Naobumi Hosogane, Justin S. Smith, Christopher I. Shaffrey, Frank Schwab, Virginie Lafage, R. Shay Bess, Morio Matsumoto, Kota Watanabe, International Spine Study Group (ISSG)

Published in: European Spine Journal | Issue 3/2018

Abstract

Purpose

Information about the cost-effectiveness of surgical procedures for adult spinal deformity (ASD) is critical for providing appropriate treatments for these patients. The purposes of this study were to compare the direct cost and cost-effectiveness of surgery for ASD in the United States (US) and Japan (JP).

Methods

Retrospective analysis of 76 US and 76 JP patients receiving surgery for ASD with ≥2-year follow-up was identified. Data analysis included preoperative and postoperative demographic, radiographic, health-related quality of life (HRQOL), and direct cost for surgery. An incremental cost-effectiveness ratio (ICER) was determined using cost/quality-adjusted life years (QALY). The cost/QALY was calculated from the 2-year cost and HRQOL data.

Results

JP exhibited worse baseline spinopelvic alignment than the US (pelvic incidence and lumbar lordosis: 35.4° vs 22.7°, p < 0.01). The US had more three-column osteotomies (50 vs 16%), and shorter hospital stay (7.9 vs 22.7 days) (p < 0.05). The US demonstrated worse postoperative ODI (41.3 vs. 33.9%) and greater revision surgery rate (40 vs 10%) (p < 0.05). Due to the high initial cost and revision frequency, the US had greater total cost ($92,133 vs. $49,647) and cost/QALY ($511,840 vs. $225,668) at 2-year follow-up (p < 0.05).

Conclusion

Retrospective analysis comparing the direct costs and cost-effectiveness of ASD surgery in the US vs JP demonstrated that the total direct costs and cost/QALY were substantially higher in the US than JP. Variations in patient cohort, healthcare costs, revision frequencies, and HRQOL improvement influenced the cost/QALY differential between these countries.

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Title: A cost-effectiveness comparisons of adult spinal deformity surgery in the United States and Japan
Authors: Mitsuru Yagi
Christopher P. Ames
Malla Keefe
Naobumi Hosogane
Justin S. Smith
Christopher I. Shaffrey
Frank Schwab
Virginie Lafage
R. Shay Bess
Morio Matsumoto
Kota Watanabe
International Spine Study Group (ISSG)
Publication date: 01-03-2018
Publisher: Springer Berlin Heidelberg
Published in: European Spine Journal / Issue 3/2018
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-017-5274-5

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

A cost-effectiveness comparisons of adult spinal deformity surgery in the United States and Japan

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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