Cost-Utility Analysis of Pedicle Screw Removal After Successful Posterior Instrumented Fusion in Thoracolumbar Burst Fractures
STUDY DESIGN.A cost-utility analysis (CUA). OBJECTIVE.The aim of this study was to determine the cost-effectiveness of pedicle screw removal after posterior fusion in thoracolumbar burst fractures. SUMMARY OF BACKGROUND DATA.Pedicle screw instrumentation is a standard fixation method for unstable th...
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| Veröffentlicht in: | Spine (Philadelphia, Pa. 1976) Pa. 1976), 2017-08, Vol.42 (15), p.E926-E932 |
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| creator | Lee, Han-Dong Jeon, Chang-Hoon Chung, Nam-Su Seo, Young-Wook |
| description | STUDY DESIGN.A cost-utility analysis (CUA).
OBJECTIVE.The aim of this study was to determine the cost-effectiveness of pedicle screw removal after posterior fusion in thoracolumbar burst fractures.
SUMMARY OF BACKGROUND DATA.Pedicle screw instrumentation is a standard fixation method for unstable thoracolumbar burst fracture. However, removal of the pedicle screw after successful fusion remains controversial because the clinical benefits remain unclear. CUA can help clinicians make appropriate decisions about optimal health care for pedicle screw removal after successful fusion in thoracolumbar burst fractures.
METHODS.We conducted a single-center, retrospective, longitudinal matched-cohort study of prospectively collected outcomes. In total, 88 consecutive patients who had undergone pedicle screw instrumentation for thoracolumbar burst fracture with successful fusion confirmed by computed tomography (CT) were used in this study. In total, 45 patients wanted to undergo implant removal surgery (R group), and 43 decided not to remove the implant (NR group). A CUA was conducted from the health care perspective. The direct costs of health care were obtained from the medical bill of each patient. Changes in health-related quality of life (HRQoL) scores, validated by Short Form 6D, were used to calculate quality-adjusted life-years (QALYs). Total costs and gained QALY were calculated at 1 year (1 year) and 2 years (2 years) compared with baseline. Results are expressed as an incremental cost-effectiveness ratio (ICER). Different discount rates (0%, 3%, and 5%) were applied to both cost and QALY for sensitivity analysis.
RESULTS.Baseline patient variables were similar between the two groups (all P > 0.05). The additional benefits of implant removal (0.201 QALY at 2 years) were achieved with additional costs ($2541 at 2 years), equating to an ICER of $12,641/QALY. On the basis of the different discount rates, the robustness of our studyʼs results was also determined.
CONCLUSION.Implant removal after successful fusion in a thoracolumbar burst fracture is cost-effective until postoperative year 2.Level of Evidence3 |
| doi_str_mv | 10.1097/BRS.0000000000001991 |
| format | Article |
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OBJECTIVE.The aim of this study was to determine the cost-effectiveness of pedicle screw removal after posterior fusion in thoracolumbar burst fractures.
SUMMARY OF BACKGROUND DATA.Pedicle screw instrumentation is a standard fixation method for unstable thoracolumbar burst fracture. However, removal of the pedicle screw after successful fusion remains controversial because the clinical benefits remain unclear. CUA can help clinicians make appropriate decisions about optimal health care for pedicle screw removal after successful fusion in thoracolumbar burst fractures.
METHODS.We conducted a single-center, retrospective, longitudinal matched-cohort study of prospectively collected outcomes. In total, 88 consecutive patients who had undergone pedicle screw instrumentation for thoracolumbar burst fracture with successful fusion confirmed by computed tomography (CT) were used in this study. In total, 45 patients wanted to undergo implant removal surgery (R group), and 43 decided not to remove the implant (NR group). A CUA was conducted from the health care perspective. The direct costs of health care were obtained from the medical bill of each patient. Changes in health-related quality of life (HRQoL) scores, validated by Short Form 6D, were used to calculate quality-adjusted life-years (QALYs). Total costs and gained QALY were calculated at 1 year (1 year) and 2 years (2 years) compared with baseline. Results are expressed as an incremental cost-effectiveness ratio (ICER). Different discount rates (0%, 3%, and 5%) were applied to both cost and QALY for sensitivity analysis.
RESULTS.Baseline patient variables were similar between the two groups (all P > 0.05). The additional benefits of implant removal (0.201 QALY at 2 years) were achieved with additional costs ($2541 at 2 years), equating to an ICER of $12,641/QALY. On the basis of the different discount rates, the robustness of our studyʼs results was also determined.
CONCLUSION.Implant removal after successful fusion in a thoracolumbar burst fracture is cost-effective until postoperative year 2.Level of Evidence3</description><identifier>ISSN: 0362-2436</identifier><identifier>EISSN: 1528-1159</identifier><identifier>DOI: 10.1097/BRS.0000000000001991</identifier><identifier>PMID: 27879575</identifier><language>eng</language><publisher>United States: Wolters Kluwer Health, Inc. All rights reserved</publisher><subject>Adult ; Cost-Benefit Analysis - trends ; Device Removal - economics ; Device Removal - trends ; Female ; Follow-Up Studies ; Fracture Fixation - economics ; Fracture Fixation - trends ; Humans ; Longitudinal Studies ; Lumbar Vertebrae - injuries ; Lumbar Vertebrae - surgery ; Male ; Middle Aged ; Pedicle Screws - economics ; Pedicle Screws - trends ; Prospective Studies ; Retrospective Studies ; Spinal Fractures - economics ; Spinal Fractures - surgery ; Spinal Fusion - economics ; Spinal Fusion - trends ; Thoracic Vertebrae - injuries ; Thoracic Vertebrae - surgery</subject><ispartof>Spine (Philadelphia, Pa. 1976), 2017-08, Vol.42 (15), p.E926-E932</ispartof><rights>Wolters Kluwer Health, Inc. All rights reserved</rights><rights>Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4011-9ade11aba6aaddf50de8eac946aa9276a4ae687944debcab34284dd6e604f8873</citedby><cites>FETCH-LOGICAL-c4011-9ade11aba6aaddf50de8eac946aa9276a4ae687944debcab34284dd6e604f8873</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27879575$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lee, Han-Dong</creatorcontrib><creatorcontrib>Jeon, Chang-Hoon</creatorcontrib><creatorcontrib>Chung, Nam-Su</creatorcontrib><creatorcontrib>Seo, Young-Wook</creatorcontrib><title>Cost-Utility Analysis of Pedicle Screw Removal After Successful Posterior Instrumented Fusion in Thoracolumbar Burst Fractures</title><title>Spine (Philadelphia, Pa. 1976)</title><addtitle>Spine (Phila Pa 1976)</addtitle><description>STUDY DESIGN.A cost-utility analysis (CUA).
OBJECTIVE.The aim of this study was to determine the cost-effectiveness of pedicle screw removal after posterior fusion in thoracolumbar burst fractures.
SUMMARY OF BACKGROUND DATA.Pedicle screw instrumentation is a standard fixation method for unstable thoracolumbar burst fracture. However, removal of the pedicle screw after successful fusion remains controversial because the clinical benefits remain unclear. CUA can help clinicians make appropriate decisions about optimal health care for pedicle screw removal after successful fusion in thoracolumbar burst fractures.
METHODS.We conducted a single-center, retrospective, longitudinal matched-cohort study of prospectively collected outcomes. In total, 88 consecutive patients who had undergone pedicle screw instrumentation for thoracolumbar burst fracture with successful fusion confirmed by computed tomography (CT) were used in this study. In total, 45 patients wanted to undergo implant removal surgery (R group), and 43 decided not to remove the implant (NR group). A CUA was conducted from the health care perspective. The direct costs of health care were obtained from the medical bill of each patient. Changes in health-related quality of life (HRQoL) scores, validated by Short Form 6D, were used to calculate quality-adjusted life-years (QALYs). Total costs and gained QALY were calculated at 1 year (1 year) and 2 years (2 years) compared with baseline. Results are expressed as an incremental cost-effectiveness ratio (ICER). Different discount rates (0%, 3%, and 5%) were applied to both cost and QALY for sensitivity analysis.
RESULTS.Baseline patient variables were similar between the two groups (all P > 0.05). The additional benefits of implant removal (0.201 QALY at 2 years) were achieved with additional costs ($2541 at 2 years), equating to an ICER of $12,641/QALY. On the basis of the different discount rates, the robustness of our studyʼs results was also determined.
CONCLUSION.Implant removal after successful fusion in a thoracolumbar burst fracture is cost-effective until postoperative year 2.Level of Evidence3</description><subject>Adult</subject><subject>Cost-Benefit Analysis - trends</subject><subject>Device Removal - economics</subject><subject>Device Removal - trends</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Fracture Fixation - economics</subject><subject>Fracture Fixation - trends</subject><subject>Humans</subject><subject>Longitudinal Studies</subject><subject>Lumbar Vertebrae - injuries</subject><subject>Lumbar Vertebrae - surgery</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Pedicle Screws - economics</subject><subject>Pedicle Screws - trends</subject><subject>Prospective Studies</subject><subject>Retrospective Studies</subject><subject>Spinal Fractures - economics</subject><subject>Spinal Fractures - surgery</subject><subject>Spinal Fusion - economics</subject><subject>Spinal Fusion - trends</subject><subject>Thoracic Vertebrae - injuries</subject><subject>Thoracic Vertebrae - surgery</subject><issn>0362-2436</issn><issn>1528-1159</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkU1r3DAQhkVpaDZp_0EpOvbiVJJlWTpulm4SCDRkk7ORpTHrVrZSfWTZS397FDYtpYdGl0HD847QMwh9pOSMEtV-Ob_dnJG_DlWKvkEL2jBZUdqot2hBasEqxmtxjE5i_F4gUVP1Dh2zVraqaZsF-rXyMVX3aXRj2uPlrN0-jhH7Ad-AHY0DvDEBdvgWJv-oHV4OCQLeZGMgxiE7fFPyEEYf8NUcU8gTzAksXuc4-hmPM77b-qCNd3nqdcDnOcSE16WTcoD4Hh0N2kX48FJP0f36693qsrr-dnG1Wl5XhhNKK6UtUKp7LbS2dmiIBQnaKF7uirVCcw2ifIlzC73Rfc2Z5NYKEIQPUrb1Kfp8mPsQ_M8MMXXTGA04p2fwOXZU8lpRoQQrKD-gJvgYAwzdQxgnHfYdJd2z-a6Y7_41X2KfXl7I_QT2T-i36gLIA7DzrhiLP1zeQei2oF3avjab_yf6jLWiLpsmtCWSUFKVDmP1E2LSoog</recordid><startdate>20170801</startdate><enddate>20170801</enddate><creator>Lee, Han-Dong</creator><creator>Jeon, Chang-Hoon</creator><creator>Chung, Nam-Su</creator><creator>Seo, Young-Wook</creator><general>Wolters Kluwer Health, Inc. All rights reserved</general><general>Copyright Wolters Kluwer Health, Inc. All rights reserved</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20170801</creationdate><title>Cost-Utility Analysis of Pedicle Screw Removal After Successful Posterior Instrumented Fusion in Thoracolumbar Burst Fractures</title><author>Lee, Han-Dong ; Jeon, Chang-Hoon ; Chung, Nam-Su ; Seo, Young-Wook</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4011-9ade11aba6aaddf50de8eac946aa9276a4ae687944debcab34284dd6e604f8873</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adult</topic><topic>Cost-Benefit Analysis - trends</topic><topic>Device Removal - economics</topic><topic>Device Removal - trends</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Fracture Fixation - economics</topic><topic>Fracture Fixation - trends</topic><topic>Humans</topic><topic>Longitudinal Studies</topic><topic>Lumbar Vertebrae - injuries</topic><topic>Lumbar Vertebrae - surgery</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Pedicle Screws - economics</topic><topic>Pedicle Screws - trends</topic><topic>Prospective Studies</topic><topic>Retrospective Studies</topic><topic>Spinal Fractures - economics</topic><topic>Spinal Fractures - surgery</topic><topic>Spinal Fusion - economics</topic><topic>Spinal Fusion - trends</topic><topic>Thoracic Vertebrae - injuries</topic><topic>Thoracic Vertebrae - surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lee, Han-Dong</creatorcontrib><creatorcontrib>Jeon, Chang-Hoon</creatorcontrib><creatorcontrib>Chung, Nam-Su</creatorcontrib><creatorcontrib>Seo, Young-Wook</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Spine (Philadelphia, Pa. 1976)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lee, Han-Dong</au><au>Jeon, Chang-Hoon</au><au>Chung, Nam-Su</au><au>Seo, Young-Wook</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cost-Utility Analysis of Pedicle Screw Removal After Successful Posterior Instrumented Fusion in Thoracolumbar Burst Fractures</atitle><jtitle>Spine (Philadelphia, Pa. 1976)</jtitle><addtitle>Spine (Phila Pa 1976)</addtitle><date>2017-08-01</date><risdate>2017</risdate><volume>42</volume><issue>15</issue><spage>E926</spage><epage>E932</epage><pages>E926-E932</pages><issn>0362-2436</issn><eissn>1528-1159</eissn><abstract>STUDY DESIGN.A cost-utility analysis (CUA).
OBJECTIVE.The aim of this study was to determine the cost-effectiveness of pedicle screw removal after posterior fusion in thoracolumbar burst fractures.
SUMMARY OF BACKGROUND DATA.Pedicle screw instrumentation is a standard fixation method for unstable thoracolumbar burst fracture. However, removal of the pedicle screw after successful fusion remains controversial because the clinical benefits remain unclear. CUA can help clinicians make appropriate decisions about optimal health care for pedicle screw removal after successful fusion in thoracolumbar burst fractures.
METHODS.We conducted a single-center, retrospective, longitudinal matched-cohort study of prospectively collected outcomes. In total, 88 consecutive patients who had undergone pedicle screw instrumentation for thoracolumbar burst fracture with successful fusion confirmed by computed tomography (CT) were used in this study. In total, 45 patients wanted to undergo implant removal surgery (R group), and 43 decided not to remove the implant (NR group). A CUA was conducted from the health care perspective. The direct costs of health care were obtained from the medical bill of each patient. Changes in health-related quality of life (HRQoL) scores, validated by Short Form 6D, were used to calculate quality-adjusted life-years (QALYs). Total costs and gained QALY were calculated at 1 year (1 year) and 2 years (2 years) compared with baseline. Results are expressed as an incremental cost-effectiveness ratio (ICER). Different discount rates (0%, 3%, and 5%) were applied to both cost and QALY for sensitivity analysis.
RESULTS.Baseline patient variables were similar between the two groups (all P > 0.05). The additional benefits of implant removal (0.201 QALY at 2 years) were achieved with additional costs ($2541 at 2 years), equating to an ICER of $12,641/QALY. On the basis of the different discount rates, the robustness of our studyʼs results was also determined.
CONCLUSION.Implant removal after successful fusion in a thoracolumbar burst fracture is cost-effective until postoperative year 2.Level of Evidence3</abstract><cop>United States</cop><pub>Wolters Kluwer Health, Inc. All rights reserved</pub><pmid>27879575</pmid><doi>10.1097/BRS.0000000000001991</doi></addata></record> |
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| ispartof | Spine (Philadelphia, Pa. 1976), 2017-08, Vol.42 (15), p.E926-E932 |
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| source | MEDLINE; Journals@Ovid Complete |
| subjects | Adult Cost-Benefit Analysis - trends Device Removal - economics Device Removal - trends Female Follow-Up Studies Fracture Fixation - economics Fracture Fixation - trends Humans Longitudinal Studies Lumbar Vertebrae - injuries Lumbar Vertebrae - surgery Male Middle Aged Pedicle Screws - economics Pedicle Screws - trends Prospective Studies Retrospective Studies Spinal Fractures - economics Spinal Fractures - surgery Spinal Fusion - economics Spinal Fusion - trends Thoracic Vertebrae - injuries Thoracic Vertebrae - surgery |
| title | Cost-Utility Analysis of Pedicle Screw Removal After Successful Posterior Instrumented Fusion in Thoracolumbar Burst Fractures |
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