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Quality of life and cost-utility of surgical treatment for patients with spinal metastases: prospective cohort study

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Abstract

Purpose

Palliative surgery for patients with spinal metastasis provides good clinical outcomes. However, there have been few studies on quality of life (QOL) and cost-utility of this surgery. We aimed to elucidate QOL and cost-utility of surgical treatment for spinal metastasis.

Methods

We prospectively analyzed 47 patients with spinal metastasis from 2010 to 2014 who had a surgical indication. Thirty-one patients who desired surgery underwent spinal surgery (surgery group). Sixteen patients who did not want to undergo spinal surgery (non-surgery group). The EuroQol 5D (EQ-5D) and relevant costs were measured at one, three, six, and 12 months after study enrollment. Health state values were obtained by Japanese EQ-5D scoring and quality-adjusted life years (QALY) gained were calculated for each group. Cost-utility was expressed as the incremental cost-utility ratio (ICUR).

Results

Health state values improved from 0.036 at study enrollment to 0.448 at 12 months in the surgery group, but deteriorated from 0.056 to 0.019 in the non-surgery group, with a significant difference between groups (P < 0.05). The mean QALY gained at 12 months were 0.433 in the surgery group and 0.024 in the non-surgery group. The mean total cost per patient in the surgery group was $25,770 compared with $8615 in the non-surgery group. The ICUR using oneyear follow-up data was $42,003/QALY gained.

Conclusions

Surgical treatment for spinal metastases is associated with significant improvement in health state value. In orthopaedic surgery, an ICUR less than $50,000/QALY gained is considered acceptable cost-effectiveness. Our results indicate that surgical treatment could be cost-effective.

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Acknowledgements

The authors thank Dr. S. Akahane and R. Harada, as well as the physical therapists J. Inoue and D. Makiura, for their assistance and helpful criticism.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan

    Shingo Miyazaki, Kenichiro Kakutani, Koichiro Maeno, Toru Takada, Takashi Yurube, Yoshiki Terashima, Masaaki Ito, Yuji Kakiuchi, Yoshiki Takeoka, Hitomi Hara, Teruya Kawamoto, Toshihiro Akisue, Ryosuke Kuroda & Kotaro Nishida

  2. Division of Rehabilitation Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan

    Yoshitada Sakai

  3. Division of Radiation Oncology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan

    Yasuo Ejima, Takuya Okada & Ryohei Sasaki

  4. Department of Palliative Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan

    Akihiro Sakashita & Yoshiyuki Kizawa

  5. Department of Medical Oncology/Hematology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan

    Naomi Kiyota & Hironobu Minami

Authors
  1. Shingo Miyazaki
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  2. Kenichiro Kakutani
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  3. Yoshitada Sakai
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  4. Yasuo Ejima
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  9. Masaaki Ito
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  10. Yuji Kakiuchi
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  11. Yoshiki Takeoka
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  12. Hitomi Hara
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  13. Teruya Kawamoto
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  14. Akihiro Sakashita
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  15. Takuya Okada
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  16. Naomi Kiyota
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  17. Yoshiyuki Kizawa
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  18. Ryohei Sasaki
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  19. Toshihiro Akisue
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  20. Hironobu Minami
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  21. Ryosuke Kuroda
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  22. Kotaro Nishida
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Corresponding author

Correspondence to Kenichiro Kakutani.

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Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethics approval

The study protocol was approved by the institutional review board of Kobe University Graduate School of Medicine.

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Cite this article

Miyazaki, S., Kakutani, K., Sakai, Y. et al. Quality of life and cost-utility of surgical treatment for patients with spinal metastases: prospective cohort study. International Orthopaedics (SICOT) 41, 1265–1271 (2017). https://doi.org/10.1007/s00264-017-3463-9

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  • DOI: https://doi.org/10.1007/s00264-017-3463-9

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