Determining patients with spinal metastases suitable for surgical intervention: A cost-effective analysis.
cost-effective analysis
neoplasm metastasis
radiation oncology
spine
surgical oncology
Journal
Cancer medicine
ISSN: 2045-7634
Titre abrégé: Cancer Med
Pays: United States
ID NLM: 101595310
Informations de publication
Date de publication:
10 2023
10 2023
Historique:
revised:
04
09
2023
received:
09
04
2023
accepted:
12
09
2023
medline:
23
10
2023
pubmed:
26
9
2023
entrez:
26
9
2023
Statut:
ppublish
Résumé
Both nonoperative and operative treatments for spinal metastasis are expensive interventions. Patients' expected 3-month survival is believed to be a key factor to determine the most suitable treatment. However, to the best of our knowledge, no previous study lends support to the hypothesis. We sought to determine the cost-effectiveness of operative and nonoperative interventions, stratified by patients' predicted probability of 3-month survival. A Markov model with four defined health states was used to estimate the quality-adjusted life years (QALYs) and costs for operative intervention with postoperative radiotherapy and radiotherapy alone (palliative low-dose external beam radiotherapy) of spine metastases. Transition probabilities for the model, including the risks of mortality and functional deterioration, were obtained from secondary and our institutional data. Willingness to pay thresholds were prespecified at $100,000 and $150,000. The analyses were censored after 5-year simulation from a health system perspective and discounted outcomes at 3% per year. Sensitivity analyses were conducted to test the robustness of the study design. The incremental cost-effectiveness ratios were $140,907 per QALY for patients with a 3-month survival probability >50%, $3,178,510 per QALY for patients with a 3-month survival probability <50%, and $168,385 per QALY for patients with independent ambulatory and 3-month survival probability >50%. This study emphasizes the need to choose patients carefully and estimate preoperative survival for those with spinal metastases. In addition to reaffirming previous research regarding the influence of ambulatory status on cost-effectiveness, our study goes a step further by highlighting that operative intervention with postoperative radiotherapy could be more cost-effective than radiotherapy alone for patients with a better survival outlook. Accurate survival prediction tools and larger future studies could offer more detailed insights for clinical decisions.
Sections du résumé
BACKGROUND
Both nonoperative and operative treatments for spinal metastasis are expensive interventions. Patients' expected 3-month survival is believed to be a key factor to determine the most suitable treatment. However, to the best of our knowledge, no previous study lends support to the hypothesis. We sought to determine the cost-effectiveness of operative and nonoperative interventions, stratified by patients' predicted probability of 3-month survival.
METHODS
A Markov model with four defined health states was used to estimate the quality-adjusted life years (QALYs) and costs for operative intervention with postoperative radiotherapy and radiotherapy alone (palliative low-dose external beam radiotherapy) of spine metastases. Transition probabilities for the model, including the risks of mortality and functional deterioration, were obtained from secondary and our institutional data. Willingness to pay thresholds were prespecified at $100,000 and $150,000. The analyses were censored after 5-year simulation from a health system perspective and discounted outcomes at 3% per year. Sensitivity analyses were conducted to test the robustness of the study design.
RESULTS
The incremental cost-effectiveness ratios were $140,907 per QALY for patients with a 3-month survival probability >50%, $3,178,510 per QALY for patients with a 3-month survival probability <50%, and $168,385 per QALY for patients with independent ambulatory and 3-month survival probability >50%.
CONCLUSIONS
This study emphasizes the need to choose patients carefully and estimate preoperative survival for those with spinal metastases. In addition to reaffirming previous research regarding the influence of ambulatory status on cost-effectiveness, our study goes a step further by highlighting that operative intervention with postoperative radiotherapy could be more cost-effective than radiotherapy alone for patients with a better survival outlook. Accurate survival prediction tools and larger future studies could offer more detailed insights for clinical decisions.
Identifiants
pubmed: 37749979
doi: 10.1002/cam4.6576
pmc: PMC10587930
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
20059-20069Informations de copyright
© 2023 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.
Références
Int Orthop. 2017 Jun;41(6):1265-1271
pubmed: 28396928
Spine J. 2021 Oct;21(10):1679-1686
pubmed: 33798728
Acta Orthop. 2021 Aug;92(4):385-393
pubmed: 33870837
J Bone Joint Surg Am. 2021 Jul 21;:
pubmed: 34288901
Int J Radiat Oncol Biol Phys. 2022 Oct 1;114(2):293-300
pubmed: 35675854
JAMA. 1996 Oct 23-30;276(16):1339-41
pubmed: 8861994
Acta Orthop. 2021 Oct;92(5):526-531
pubmed: 34109892
Spine J. 2019 Jan;19(1):144-156
pubmed: 29864546
Lancet Oncol. 2022 Jul;23(7):e321-e333
pubmed: 35772464
Clin Orthop Relat Res. 2021 Jun 1;479(6):1311-1319
pubmed: 33543875
Clin Orthop Relat Res. 2019 Dec;477(12):2798-2803
pubmed: 31764353
J Am Acad Orthop Surg. 2011 Jan;19(1):37-48
pubmed: 21205766
J Bone Joint Surg Am. 2016 Mar 2;98(5):396-402
pubmed: 26935462
Cancer Med. 2014 Oct;3(5):1359-67
pubmed: 25044999
J Bone Joint Surg Am. 2017 Jul 5;99(13):e71
pubmed: 28678132
Spine J. 2020 Apr;20(4):572-579
pubmed: 31712164
Spine J. 2015 Nov 1;15(11):2345-50
pubmed: 26160329
PLoS One. 2017 Dec 29;12(12):e0190342
pubmed: 29287117
BMC Cancer. 2015 May 05;15:354
pubmed: 25939658
Lancet. 2005 Aug 20-26;366(9486):643-8
pubmed: 16112300
J Orthop. 2021 Nov 27;28:134-139
pubmed: 34924728
Spine J. 2021 Jan;21(1):28-36
pubmed: 32087387
Neuro Oncol. 2012 May;14(5):631-40
pubmed: 22505658
Radiat Oncol. 2012 Oct 12;7:168
pubmed: 23062178
Spine J. 2021 Mar;21(3):492-499
pubmed: 33098985
Spine J. 2018 Oct;18(10):1956-1958
pubmed: 30055261
World Neurosurg. 2019 May;125:e537-e543
pubmed: 30716490
Br J Neurosurg. 2016 Jun;30(3):337-44
pubmed: 26901574
J Neurosurg Spine. 2021 Feb 26;34(5):779-787
pubmed: 33636704
Spine J. 2018 Jun;18(6):935-940
pubmed: 29031992
Spine J. 2022 Apr;22(4):595-604
pubmed: 34699994
Clin Orthop Relat Res. 2021 Jun 1;479(6):1320-1322
pubmed: 34004624
Lancet Oncol. 2021 Jul;22(7):1023-1033
pubmed: 34126044
Clin Orthop Relat Res. 2013 Feb;471(2):628-39
pubmed: 23179121
AIP Conf Proc. 2010 Jan 5;1204:17-21
pubmed: 20733932
Spine J. 2020 Oct;20(10):1646-1652
pubmed: 32428674
Spine J. 2021 Oct;21(10):1670-1678
pubmed: 33545371
Radiother Oncol. 2022 Oct;175:159-166
pubmed: 36067909
Cancer Med. 2023 Oct;12(19):20059-20069
pubmed: 37749979
Neurosurgery. 2023 Oct 1;93(4):813-823
pubmed: 37074052
Cancer. 2019 Aug 1;125(15):2631-2637
pubmed: 30985913
Oncologist. 2013 Jun;18(6):744-51
pubmed: 23709750
J Bone Joint Surg Am. 2016 Nov 2;98(21):1767-1776
pubmed: 27807108
Spine J. 2020 Jan;20(1):14-21
pubmed: 31505303
World Neurosurg. 2018 Jan;109:e389-e397
pubmed: 28987846
Arch Orthop Trauma Surg. 2012 Jun;132(6):765-71
pubmed: 22327407
J Neurosurg Spine. 2020 Jun 5;:1-11
pubmed: 32502990
Neurosurgery. 2019 Oct 1;85(4):E671-E681
pubmed: 30869143
Value Health. 2022 Jan;25(1):3-9
pubmed: 35031096