Comparisons of direct costs, outcomes, and cost-utility of decompression surgery with fusion versus decompression alone for degenerative lumbar spondylolisthesis

Background: Cost-utility analysis of surgery for degenerative lumber spondylolisthesis (DS) is essential for healthcare providers and patients to select appropriate treatment. The purpose of this study was to review the cost-utility of decompression alone versus decompression with fusion for DS. Methods: A retrospective review of 99 consecutive patients who were treated for Meyerding grade 1 DS at two representative spine centers was performed. Patients with significant spinal instability were treated by decompression with fusion (F group, 40 patients); all others were treated by decompression surgery alone (D group, 59 patients). All patients were followed for three years. Demographic and radiographic data, health-related quality of life (HRQoL), and the direct cost for surgery were analyzed, and the incremental cost-effectiveness ratio (ICER) was determined using cost/quality-adjusted life years (QALY). Results: There were no differences between the groups in baseline demographics (D vs. F: age 68 +/- 9 vs. 66 +/- 7 years; 37% vs. 40% female) or HRQoL (ODI: D, 41 +/- 16 vs. F, 46 +/- 13%). The F group had a higher initial-surgery cost ($18,992 +/- 2932) but lower reoperation frequency (7%) than the D group ($7660 +/- 2182 and 12%, respectively). The three-year total direct cost was higher for F than for D ($19,222 +/- 3332 vs. $9668 +/- 6,168, p = .01). ICER was higher for F at one year ($136,408 +/- 187,911 vs. $237,844 +/- 212,049, p <.01), but was comparable for F and D at three years (D, $41,923 +/- 44,503 vs. F, $51,313 +/- 32,849, p = .17). Conclusion: At the three-year follow-up, the two methods had comparable cost-utility. Both methods were cost-effective (defined as an ICER within three times the per-capita gross domestic product). (C) 2018 Published by Elsevier B.V. on behalf of The Japanese Orthopaedic Association.