A new study published in Spine compares cost-effectiveness of operative and non-operative treatment for geriatric type-II odontoid fractures.
The study authors compared operative and non-operative treatment of patients 65 years to 74 years old; 75 years to 84 years old; and those older than 84 who underwent treatment for type-II odontoid fractures. The researchers found:
1. Treatment was costliest in the 65 year to 74 year-old cohort undergoing surgery, reaching $53,407. Non-operative treatment cost $30,553 on average.
2. Surgery was more effective in the 65 year to 74-year-old group, reporting 12 quality-adjusted life years compared to 10.11 QALY for the other cohorts. The incremental cost-effectiveness ratio was $40,467 per QALY.
3. The over-84 years-old cohort primarily underwent non-operative treatment, which was more costly at $45,978 compared to $28,872 for the operative group. The non-operative treatment was also less effective, reporting 2.48 QALY compared to 3.73 QALY.
4. Operative treatment was cost effective in patients aged 65 years to 84 years old if $100,000 per QALY is the benchmark.
5. The authors used a study model that was robust to sensitivity analysis and took into account the disutility of complications and delayed surgery as well as the non-union and complication probability.