Surgical Versus Non-Surgical Treatment of Thoracolumbar Burst Fractures In Neurologically Intact Patients: A Cost-Utility Analysis
Moderator
Alexander Joeris, MSc, MD, AO Foundation, Zizers, Switzerland
Speakers
Cumhur Öner; Charlotte Dandurand; Klaus Schnake; Richard J Bransford; Greg Schroeder; Nicolas Dea; Mark Phillips; Mohammed El-Sharkawi; Shanmuganathan Rajasekaran; Lorin Benneker; Jin Tee; Eugen Cezar Popescu; Jérôme Paquet; John France; Alexander Vaccaro; Marcel Dvorak
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)