Surgical Versus Non-Surgical Treatment of Thoracolumbar Burst Fractures In Neurologically Intact Patients: A Cost-Utility Analysis
Author(s)
Alexander Joeris, MSc, MD1, Cumhur F. Öner, MD PhD2, Charlotte Dandurand, MD MSc FRCSC3, Klaus J. Schnake, MD4, Richard J Bransford, MD5, Greg D. Schroeder, MD Associate Professor6, Nicolas Dea, MD, MSc, FRCSC7, Mark Phillips, BSc, PhD8, Mohammed El-Sharkawi, .9, Shanmuganathan Rajasekaran, .10, Lorin M. Benneker, .11, Jin W. Tee, .12, Eugen Cezar Popescu, .13, Jérôme Paquet, .14, John C. France, .15, Alexander R. Vaccaro, MD, MBA, PhD16, Marcel F. Dvorak, MD, FRCSC, MBA17;
1AO Foundation, Head of Medical Scientific Affairs, Davos, Switzerland, 2University Medical Center, Utrecht, Netherlands, 3University of British Columbia, Department of British Columbia, Vancouver, BC, Canada, 4Malteser Waldkrankenhaus St. Marien, Center of Spinal Surgery and Scoliosis, Erlangen, Germany, 5University of Washington School of Medicine, Department of Orthopaedics and Department of Neurological Surgery, Seattle, WA, USA, 6Thomas Jefferson University, Rothman Institute, Philadelphia, PA, USA, 7University of British Columbia, Vancouver, BC, Canada, 8McMaster University, Hamilton, ON, Canada, 9Assiut University Medical School Assiut, Department of Orthopaedic and Trauma Surgery, Asyut, Egypt, 10Ganga Hospital, Department of Orthopaedics and Spine Surgery, Coimbatore, Tamil Nadu, India, 11University of Bern, Spine Unit, Sonnenhof Spital, Bern, Switzerland, 12National Trauma Research Institute (NTRI), The Alfred Hospital, Department of Neurosurgery, Melbourne, Australia, 13Prof. Dr. N. Oblu Emergency Hospital, Iasi, Romania, 14Université Laval, Neurosurgery Unit, Department of Surgery, CHU de Quebec, Quebec City, QC, Canada, 15West Virginia University, Department of Orthopaedic Surgery, WV, USA, 16Thomas Jefferson University Hospital, Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, PA, USA, 17University of British Columbia, Department of Orthopaedics, Vancouver, BC, Canada
1AO Foundation, Head of Medical Scientific Affairs, Davos, Switzerland, 2University Medical Center, Utrecht, Netherlands, 3University of British Columbia, Department of British Columbia, Vancouver, BC, Canada, 4Malteser Waldkrankenhaus St. Marien, Center of Spinal Surgery and Scoliosis, Erlangen, Germany, 5University of Washington School of Medicine, Department of Orthopaedics and Department of Neurological Surgery, Seattle, WA, USA, 6Thomas Jefferson University, Rothman Institute, Philadelphia, PA, USA, 7University of British Columbia, Vancouver, BC, Canada, 8McMaster University, Hamilton, ON, Canada, 9Assiut University Medical School Assiut, Department of Orthopaedic and Trauma Surgery, Asyut, Egypt, 10Ganga Hospital, Department of Orthopaedics and Spine Surgery, Coimbatore, Tamil Nadu, India, 11University of Bern, Spine Unit, Sonnenhof Spital, Bern, Switzerland, 12National Trauma Research Institute (NTRI), The Alfred Hospital, Department of Neurosurgery, Melbourne, Australia, 13Prof. Dr. N. Oblu Emergency Hospital, Iasi, Romania, 14Université Laval, Neurosurgery Unit, Department of Surgery, CHU de Quebec, Quebec City, QC, Canada, 15West Virginia University, Department of Orthopaedic Surgery, WV, USA, 16Thomas Jefferson University Hospital, Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, PA, USA, 17University of British Columbia, Department of Orthopaedics, Vancouver, BC, Canada
Presentation Documents
OBJECTIVES: Studies comparing clinical outcomes of patients with neurologically intact thoracolumbar (TL) burst fractures have produced inconclusive results creating lack of consensus. The goal of the current AO Spine study was to perform a cost-utility analysis comparing surgical treatment to non-surgical treatment for neurologically intact TL burst fractures.
METHODS: We performed a cost-utility analysis from a societal perspective. Patient demographics and all clinical and outcome data were taken from an observational, prospective multicenter cohort study comparing surgical versus non-surgical treatment of TL burst fractures in neurological intact patients. Costs were taken from the clinical study which included patient diaries with productivity loss documented, current scientific literature in addition to national and international healthcare costing guidelines and databases. The Incremental Cost Effectiveness Ratio (ICER) was calculated comparing surgical versus non-surgical treatment for the three different time-horizons. Additionally, sensitivity analysis was performed to test for robustness of the results.
RESULTS: 211 patients from eleven sites from different regions (North America, Europe, Middle east, and Asia) were included. 61.0 % (n=130) were treated surgically and 39% (n=83) non-surgically. At one-year, the ICER for surgical treatment was $191,648.00 USD per QALY. Therefore, compared to a willingness to pay threshold of $100,000, surgical treatment was not cost-effective. At 2 years, surgical treatment showed to be a dominant strategy with $28,978.50 savings per QALY, mainly due to a higher rate of average working days lost and caregiver time in the non-surgical group. At lifetime horizon, surgical treatment remained the cost-effective strategy at $25,530.18 savings per QALY.
CONCLUSIONS: Our cost-utility analysis showed surgical management to be cost-effective from two years onwards from a societal perspective. This finding was maintained through the working-lifetime horizon. This investigation highlights the viability for surgical management of TL burst fractures to provide societal benefit especially when productivity is valued.
METHODS: We performed a cost-utility analysis from a societal perspective. Patient demographics and all clinical and outcome data were taken from an observational, prospective multicenter cohort study comparing surgical versus non-surgical treatment of TL burst fractures in neurological intact patients. Costs were taken from the clinical study which included patient diaries with productivity loss documented, current scientific literature in addition to national and international healthcare costing guidelines and databases. The Incremental Cost Effectiveness Ratio (ICER) was calculated comparing surgical versus non-surgical treatment for the three different time-horizons. Additionally, sensitivity analysis was performed to test for robustness of the results.
RESULTS: 211 patients from eleven sites from different regions (North America, Europe, Middle east, and Asia) were included. 61.0 % (n=130) were treated surgically and 39% (n=83) non-surgically. At one-year, the ICER for surgical treatment was $191,648.00 USD per QALY. Therefore, compared to a willingness to pay threshold of $100,000, surgical treatment was not cost-effective. At 2 years, surgical treatment showed to be a dominant strategy with $28,978.50 savings per QALY, mainly due to a higher rate of average working days lost and caregiver time in the non-surgical group. At lifetime horizon, surgical treatment remained the cost-effective strategy at $25,530.18 savings per QALY.
CONCLUSIONS: Our cost-utility analysis showed surgical management to be cost-effective from two years onwards from a societal perspective. This finding was maintained through the working-lifetime horizon. This investigation highlights the viability for surgical management of TL burst fractures to provide societal benefit especially when productivity is valued.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EE5
Topic
Economic Evaluation
Disease
SDC: Injury & Trauma, SDC: Musculoskeletal Disorders (Arthritis, Bone Disorders, Osteoporosis, Other Musculoskeletal)