Glassman, Steven DCarreon, Leah YShaffrey, Christopher IKelly, Michael PCrawford, Charles HYanik, Elizabeth LLurie, Jon DBess, R ShayBaldus, Christine RBridwell, Keith H2023-06-192023-06-192020-122212-134X2212-1358https://hdl.handle.net/10161/28126<h4>Study design</h4>Longitudinal comparative cohort.<h4>Objective</h4>The purpose of this study is to report on the cost-effectiveness of surgical versus non-surgical treatment for Adult Symptomatic Lumbar Scoliosis (ASLS) using the as-treated data and provide a comparison to previously reported intent-to-treat (ITT) analysis. Adult spinal deformity is a relatively prevalent condition for which surgical treatment has become increasingly common but concerns surrounding complications, revision rates and cost-effectiveness remain unresolved. Of these issues, cost-effectiveness is perhaps the most difficult to quantify as the requisite data is difficult to obtain. The purpose of this study is to report on the cost-effectiveness of surgical versus non-surgical treatment for ASLS using the as-treated data and provide a comparison to previously reported ITT analysis.<h4>Methods</h4>Patients with at least 5-year follow-up data within the same treatment arm were included. Data collected every 3 months included use of nonoperative modalities, medications and employment status. Costs for surgeries and non-operative modalities were determined using Medicare Allowable rates. Medication costs were determined using the RedBook and indirect costs were calculated based on the reported employment status and income. Quality-Adjusted Life Years (QALY) was determined using the SF-6D.<h4>Results</h4>Of 226 patients, 195 patients (73 Non-op, 122 Op) met inclusion criteria. At 5 years, 29 (24%) patients in the Op group had a revision surgery of whom two had two revisions and one had three revisions. The cumulative cost for the Op group was $111,451 with a cumulative QALY gain of 2.3. The cumulative cost for the Non-Op group was $29,124 with a cumulative QALY gain of 0.4. This results in an ICER of $44,033 in favor of Op treatment.<h4>Conclusion</h4>This as-treated cost-effectiveness analysis demonstrates that surgical treatment for adult lumbar scoliosis becomes favorable at year-three, 1 year earlier than suggested by a previous intent-to-treat analysis.<h4>Level of evidence</h4>II.Lumbar VertebraeHumansScoliosisSpinal FusionCohort StudiesFollow-Up StudiesTime FactorsAdultAgedAged, 80 and overMiddle AgedCost-Benefit AnalysisFemaleMaleConservative TreatmentJournal article2023-06-19