Cost-effectiveness of Posterior/Transforaminal Lumbar Interbody Fusion for Grade 1 Lumbar Spondylolisthesis: A 5-Year Quality Outcomes Database Study

Sunday, May 5, 2024

2:28 PM – 2:33 PM CT

Location: N427bc

Presenting Author(s)

Timothy J. Yee, MD

Fellow in Neurological Surgery
Department of Neurological Surgery, UCSF
San Francisco, CA, US

Co-Author(s)

Nima Alan, MD

Neurosurgeon
UCSF
Phoenix, Arizona, United States
Anthony L. Asher, MD

President AANS, Clinical Professor
Neuroscience Institute, Carolina Neurosurgery & Spine Associates
Charlotte, North Carolina, United States
Erica F. Bisson, MD, MPH

Professor
University of Utah
Salt Lake City, UT, US
Mohamad Bydon, MD, FAANS

Professor of Neurosurgery
Mayo Clinic
Rochester, MN, US
Andrew K. Chan, MD

Assistant Professor of Neurological Surgery
Columbia University Irving Medical Center
New York, NY, US
Dean Chou, MD

Chief of the Spine Division, Professor, and Vice Chair of Neurosurgery
Columbia University
New York, New York, United States
Domagoj Coric, MD

Neurosurgeon
Carolina Neurosurgery & Spine Associates
Charlotte, NC, US
Anthony M. DiGiorgio, DO, MHA

Assistant Professor
Department of Neurological Surgery, University of California, San Francisco
San Francisco, California, United States
Kevin T. Foley, MD

Professor
Semmes-Murphey Neurologic and Spine Institute, University of Tennessee
Memphis, TN, US
KF

Kai-Ming Fu, MD, PhD

Associate Professor
Weill Cornell Medical Center
New York, NY, US
Steven D. Glassman, MD (he/him/his)

Medical Director
Norton Leatherman Spine Center
Louisville, KY, US
Regis William Haid, Jr., MD

Neurosurgeon
Atlanta Brain and Spine
Atlanta, GA, US
Sarah E. Johnson, MBBS

Postdoctoral Research Fellow
Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55902, USA
John Knightly, MD, FAANS (he/him/his)

Vice President
AANS
Cedar Knolls, NJ, US
David Liles, MD

Resident
Vanderbilt University Medical Center
Nashville, TN, US
SM

Scott Meyer, MD

Neurosurgeon
Altair Health
Minneapolis, Minnesota, United States
Praveen V. Mummaneni, MD, MBA

Joan O'Reilly Endowed Professor and Vice Chair of Neurosurgery
Department of Neurological Surgery, University of California, San Francisco
San Francisco, CA, US
PP

Paul Park, MD

Professor of Neurosurgery
Semmes-Murphey Neurologic and Spine Institute
MEMPHIS, TN, US
Eric Potts, MD

Neurosurgeon
Goodman Campbell Brain and Spine
Carmel, IN, US
Christopher I. Shaffrey, MD

Professor of Spine Surgery
Duke University Medical Center
Durham, NC, US
MS

Mark Shaffrey, MD

Chair - Department of Neurosurgery
University of Virginia
Charlottesville, VA, US
JS

Jonathan R. Slotkin, MD

Surgeon
Geisinger Health
Danville, Pennsylvania, United States
MV

Michael S. Virk, MD, PhD

Assistant Professor
Weill Cornell Medical Center
New York, New York, United States
Michael Y. Wang, MD

Professor
University of Miami
Miami, FL, US

Disclosure(s):

Timothy J. Yee, MD: No financial relationships to disclose

Nima Alan, MD: No financial relationships to disclose

Anthony L. Asher, MD: Globus: Royalty Recipient (Ongoing)

Erica F. Bisson, MD, MPH: No financial relationships to disclose

Mohamad Bydon, MD, FAANS: No financial relationships to disclose

Andrew K. Chan, MD: No financial relationships to disclose

Dean Chou, MD: Cerapedics: Grant/Research Support (Ongoing); Cervical Scoliosis Research Society: Grant/Research Support (Ongoing); Globus Medical: Research Grant (Ongoing); Medtronic: Research Grant (Ongoing); Nuvasive: Research Grant (Ongoing); Royal Biologics: Consultant (Ongoing); Spine Committee: Board Member/Officer/Trustee (Ongoing); Spinevision: Consultant (Ongoing); SpineWave: Consultant (Ongoing); Terumo: Consultant (Ongoing)

Domagoj Coric, MD: 3Spine: Stock Shareholder (excluding mutual funds) (Ongoing); Globus Medical: Royalty Recipient (Ongoing); Medtronic: Consultant (Ongoing), Royalty Recipient (Ongoing); Premia Spine: Consultant (Ongoing), Stock Shareholder (excluding mutual funds) (Ongoing); Pressio: Stock Shareholder (excluding mutual funds) (Ongoing); Spine Wave: Consultant (Ongoing), Royalty Recipient (Ongoing), Stock Shareholder (excluding mutual funds) (Ongoing)

Anthony M. DiGiorgio, DO, MHA: AOSpine Foundation: Grant/Research Support (Ongoing); DePuy Synthes Spine: Grant/Research Support (Ongoing)

Kevin T. Foley, MD: Accelus: Stock Shareholder (excluding mutual funds) (Ongoing); Discgenics: Stock Shareholder (excluding mutual funds) (Ongoing); DuraStat: Stock Shareholder (excluding mutual funds) (Ongoing); Medtronic: Consultant (Ongoing), Royalty Recipient (Ongoing), Stock Shareholder (excluding mutual funds) (Ongoing); RevBio: Stock Shareholder (excluding mutual funds) (Ongoing); True Digital Surgery: Stock Shareholder (excluding mutual funds) (Ongoing); Vori Health: Stock Shareholder (excluding mutual funds) (Ongoing)

Kai-Ming Fu, MD, PhD: ATEC: Consultant (Terminated, December 1, 2023); Bioventus: Consultant (Ongoing); DePuy: Consultant (Ongoing)

Steven D. Glassman, MD: No financial relationships to disclose

Regis William Haid, MD, Jr.: Globus Medical: Royalty Recipient (Ongoing), Stock Shareholder (excluding mutual funds) (Ongoing); MDT: Royalty Recipient (Ongoing)

Sarah E. Johnson, MBBS: No financial relationships to disclose

John Knightly, MD, FAANS: No financial relationships to disclose

David Liles, MD: No financial relationships to disclose

Praveen V. Mummaneni, MD, MBA: AO Spine: Grant/Research Support (Ongoing); BK Medical: Speaker/Honoraria (Ongoing); Brainlab: Speaker/Honoraria (Ongoing); Depuy Synthes: Consultant (Ongoing); DOD: Research Grant (Ongoing); Globus: Consultant (Ongoing); ISSG: Grant/Research Support (Ongoing); NIH: Research Grant (Ongoing); NREF: Grant/Research Support (Ongoing); Pacira: Grant/Research Support (Ongoing); PCORI: Grant/Research Support (Ongoing); SI Bone: Speaker/Honoraria (Ongoing); SLIP II: Grant/Research Support (Ongoing); Springer Publisher: Royalty Recipient (Ongoing); Thieme Publisher: Royalty Recipient (Ongoing)

Paul Park, MD: Accelus: Consultant (Ongoing); Cerapedics: Grant/Research Support (Terminated, July 15, 2022); Depuy Spine: Consultant (Terminated, July 15, 2022), Grant/Research Support (Terminated, July 15, 2022); Globus Medical: Consultant (Ongoing), Royalty Recipient (Ongoing); ISSG: Grant/Research Support (Ongoing); Medtronic: Consultant (Ongoing); Nuvasive: Consultant (Ongoing); SI Bone: Grant/Research Support (Terminated, July 15, 2022); SMISS: Grant/Research Support (Ongoing)

Eric Potts, MD: Medtronic: Consultant (Ongoing), Royalty Recipient (Ongoing)

Christopher I. Shaffrey, MD: No financial relationships to disclose

Mark Shaffrey, MD: No financial relationships to disclose

Michael Y. Wang, MD: Depuy-Synthes: Consultant (Ongoing), Royalty Recipient (Ongoing); ISD: Stock Shareholder (excluding mutual funds) (Ongoing); Kinesiometrics: Stock Shareholder (excluding mutual funds) (Ongoing); Medical Device Partners: Stock Shareholder (excluding mutual funds) (Ongoing); NuVasive: Consultant (Ongoing); Pacira Pharmaceuticals: Consultant (Ongoing); Spineology: Consultant (Ongoing); Stryker: Consultant (Ongoing)

Introduction: Posterior and/or transforaminal lumbar interbody fusion (P/TLIF) is a commonly performed operation for lumbar spondylolisthesis refractory to conservative management. Its long-term cost effectiveness has not been well described.

Methods: Patients enrolled in the prospective, multicenter Quality Outcomes Database grade 1 lumbar spondylolisthesis module were included if they underwent single-stage P/TLIF. EQ5D scores at baseline, 3 months, 12 months, 24 months, 36 months, and 60 months were used to calculate gains in quality-adjusted life years (QALYs) associated with surgery relative to preoperative baseline. Healthcare-related costs associated with index surgery and related reoperations were estimated using the Medicare fee schedule and average DRG payments converted to costs based on Medicare reimbursement rates. Cost per QALY gained over 60 months postoperatively was assessed.

Results: Across 12 surgical centers, 385 patients were identified. Mean (95% CI) age was 60.2 (59.1-61.3) years, and 38% were male. Reoperation rate was 5.7%. Across the entire cohort, mean (95% CI) QALY gain at 60 months postoperatively was 1.07 (0.97-1.18), and the mean (95% CI) cost of P/TLIF was $34,092 ($33,253-$34,931). P/TLIF was associated with a mean 60-month cost per QALY gained of $31,805. Among those who did not undergo reoperation (n=363), mean (95% CI) 60-month QALY gain was 1.10 (0.99-1.20), and cost per QALY gained was $29,413. Among those who underwent reoperation (n=22), mean (95% CI) 60-month QALY gain was 0.67 (0.21-1.15), and cost per QALY gained was $92,281. Results were similar when restricting analysis to those aged 65 years and older.

Conclusion : P/TLIF was associated with a mean 60-month cost per QALY gained of $31,805 with Medicare fees. This compares favorably to established cost per QALY thresholds of $100,000, suggesting cost-effectiveness of the operation for grade 1 lumbar spondylolisthesis. Cost effectiveness persists even when limiting analysis to those who underwent reoperation.