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A cost-effectiveness comparisons of adult spinal deformity surgery in the United States and Japan

European Spine Journal volume 27, pages 678–684 (2018)Cite this article

Abstract

Purpose

Information about the cost-effectiveness of surgical procedures for adult spinal deformity (ASD) is critical for providing appropriate treatments for these patients. The purposes of this study were to compare the direct cost and cost-effectiveness of surgery for ASD in the United States (US) and Japan (JP).

Methods

Retrospective analysis of 76 US and 76 JP patients receiving surgery for ASD with ≥2-year follow-up was identified. Data analysis included preoperative and postoperative demographic, radiographic, health-related quality of life (HRQOL), and direct cost for surgery. An incremental cost-effectiveness ratio (ICER) was determined using cost/quality-adjusted life years (QALY). The cost/QALY was calculated from the 2-year cost and HRQOL data.

Results

JP exhibited worse baseline spinopelvic alignment than the US (pelvic incidence and lumbar lordosis: 35.4° vs 22.7°, p < 0.01). The US had more three-column osteotomies (50 vs 16%), and shorter hospital stay (7.9 vs 22.7 days) (p < 0.05). The US demonstrated worse postoperative ODI (41.3 vs. 33.9%) and greater revision surgery rate (40 vs 10%) (p < 0.05). Due to the high initial cost and revision frequency, the US had greater total cost ($92,133 vs. $49,647) and cost/QALY ($511,840 vs. $225,668) at 2-year follow-up (p < 0.05).

Conclusion

Retrospective analysis comparing the direct costs and cost-effectiveness of ASD surgery in the US vs JP demonstrated that the total direct costs and cost/QALY were substantially higher in the US than JP. Variations in patient cohort, healthcare costs, revision frequencies, and HRQOL improvement influenced the cost/QALY differential between these countries.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku-ku, Tokyo, Japan

    Mitsuru Yagi, Morio Matsumoto & Kota Watanabe

  2. Department of Orthopaedic Surgery, National Hospital Organization, Murayama Medical Center, Tokyo, Japan

    Mitsuru Yagi

  3. Department of Neurological Surgery, University of California, San Francisco, CA, USA

    Christopher P. Ames & Malla Keefe

  4. Department of Orthopaedic Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan

    Naobumi Hosogane

  5. Department of Neurosurgery, University of Virginia Health System, Charlottesville, VA, USA

    Justin S. Smith & Christopher I. Shaffrey

  6. Spine Service, Hospital for Special Surgery, New York, NY, USA

    Frank Schwab & Virginie Lafage

  7. Presbyterian/St. Luke’s Medical Center and Rocky Mountain Hospital for Children, Denver, CO, USA

    R. Shay Bess

Authors
  1. Mitsuru Yagi
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  2. Christopher P. Ames
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  3. Malla Keefe
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  4. Naobumi Hosogane
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  5. Justin S. Smith
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  6. Christopher I. Shaffrey
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  7. Frank Schwab
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  8. Virginie Lafage
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  9. R. Shay Bess
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  10. Morio Matsumoto
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  11. Kota Watanabe
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International Spine Study Group (ISSG)

Corresponding author

Correspondence to Kota Watanabe.

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The authors declare that they have no conflict of interest.

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This study was approved by the institutional review board.

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Yagi, M., Ames, C.P., Keefe, M. et al. A cost-effectiveness comparisons of adult spinal deformity surgery in the United States and Japan. Eur Spine J 27, 678–684 (2018). https://doi.org/10.1007/s00586-017-5274-5

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  • DOI: https://doi.org/10.1007/s00586-017-5274-5

Keywords

  • Adult spinal deformity
  • Cost
  • Cost-effectiveness
  • QALY
  • Complication