Next paper is Cost-Utility Analysis of Cervical Deformity Surgeries Using One-Year Outcomes. Thank you for the opportunity. I'm currently a NeuroSpine Fellow at University of Pennsylvania Hospital. So I'm going to talk about cost-utility analysis of cervical deformity patients with a one-year reported outcome. Nothing to disclose. So with the advances in the understanding of overall surgical alignment and osteotomy techniques and improved patient safety for cervical deformity correction surgery, there has been more and more commonly more work has been done in terms of cost-utility analysis in these patients. So current healthcare climate is diminishing resources essentially demands justification of these sources. So cost-utility analysis estimates truly the ratio of cost of intervention to the benefit we get in terms of quality of just life years for cervical deformity patients. So objective was essentially the cervical deformity correction in terms of cost-utility and value-based healthcare, which has not been previously evaluated. Our objective was to determine the cost-utility ratio of cervical deformity correction in terms of reimbursement of quality-adjusted life years. Primarily a retrospective review of a prospectively collected data with the Merter Center for Cervical Deformity Database, primarily all patients more than the age of 18 year with a minimum of one year fall apart, including this study. Cervical deformity was primarily defined as a radiographic criteria with having at least one of these following aims, classification for cervical deformity parameters, meaning C2 to C7 sagittal cob angle more than 10, chronic cob angle more than 10 degree, or C2 to C7 sagittal vertical axis or SVA more than 4 centimeter. Horizontal gaze impairment were primarily assessed with the chin bro vertical angle, or we call it CBVA, more than 25 degree. Patients with active tumor infection were essentially excluded from the study. Costs were assigned using Medicare one-year reimbursement for different levels of cervical spine fused, essentially nine plus level for posterior fusion, four to eight levels for posterior and anterior fusion, four to eight levels with primarily only anterior, four to eight levels posterior refusion, or two to three level anterior fusion with posterior fusion. Reoperations and deaths were added and finally subtracted from the utility afterwards. So quality adjusted life years were calculated by European quality of life 5D and neck disability index mapped to SF60 index. Quality adjusted life years per dollar spent were calculated using standardized methodology at one-year time point and subsequent time points relying on maintenance of one-year utility. So here is our data. Looking at demographics and surgical details, we can see 84 patients with mean average age of 61 years, 60% female with a BMI of average BMF 30, average levels of level fused in cervical deformity surgery were 7.2, 50% patients had osteotomies performed, and about 50% had posterior fusions, about 16% had anterior only. Anterior versus posterior combined, 32% and about around like 3.5% of patients had posterior, followed by anterior, followed by posterior fusions. Some more details on radiographic improvement and procedural cost, we can see average operative time was six hours. Patients presented with severe baseline cervical deformity, essentially average C2 to C7 SVA was about 48 millimeter. With the chin bow vertical angle, average was 5.4. Average T1 slope with cervical lodosis was, which is surrogate of PILL mismatch for cervical spine was 37 degree. All patients with cervical and T1 cervical slope and cervical lodosis are significantly improved from pre- to post-operative time points. If you look at the cost, essentially with index procedures, we can see about significant cost was seen, 4 to 8 level posterior fusion with the anterior fusion, and lower cost was seen in 4 to 8 levels of anterior fusion surgery. So one year average reimbursement for surgery was $55,000 in one year with eight revisions and three deaths. Cost for quality adjusted life years, one year follow-up was $646,000 by European 5D and $77,000 by NDI NSF-60. So if one year benefit is sustained, the upper threshold for cost effectiveness was reached in about from 3 to 4.5 years after cervical deformity surgery. Here's a graphical analysis looking at cost for quality adjusted life years. With the follow-up, we can see where x-axis represents the years benefit sustained, and however, y-axis represents the cost per quality adjusted life years. We can see essentially from 3 to 4 years, we can see the upper cost threshold. All patients essentially had upper cost utility threshold achieved. However, looking at 6 to 7 years postoperatively, we can see lower cost utility threshold was attained in almost all patients looking at European 5D quality of life or neck disability index with SF-60. So in conclusion, Medicare one year average reimbursement compared to one year quality adjusted life year described $646,000 for European 5D quality of life and then $477,000 for neck disability index for SF-60. Cervical deformity surgeries reached accepted cost effectiveness threshold when benefits sustained over 3 to 4, 4.5 years. However, a long-term follow-up is needed essentially for more definitive cost analysis, but this data I think is important stuff in terms of justifying cost utility ratio in these massive cervical deformity correction surgeries. Thank you so much.

NeuroSpine Fellow

University of Pennsylvania Hospital

cost-utility analysis

cervical deformity surgeries

one-year outcomes