The researchers examined cohorts of 25 patients who underwent decompression, decompression with instrumented posterolateral fusion, decompression with instrumented posterior lumbar interbody fusion/transforaminal lumbar interbody fusion and decompression with instrumented PLF and posterior lumbar interbody fusion/transforaminal lumbar interbody fusion.
The researchers found:
1. The EuroQoI 5 Dimension quality adjusted life year scores improved for all the patients.
2. The one-year cost-utility ratio for the patients who underwent just the decompression was significantly lower than the other cohorts:
• Decompression: $56,610
• Decompression with instrumented posterolateral fusion: $116,991
• Decompression with instrumented PLIF/TLIF: $109,740
• Decompression with instrumented PLIF and PLIF/TLIF: $107,546
3. The one-year incremental cost-effectiveness ratio for each cohort relative to the decompression group was:
• Decompression with instrumented posterolateral fusion: dominated
• Decompression with instrumented PLIF/TLIF: $1.06 million per QALY gained
• Decompression with instrumented PLIF and PLIF/TLIF: $830,047 per QALY gained
4. The decompression without fusion was cost-effective for the patients, but the decompression with fusion wasn’t cost effective within the first year after surgery with these patients.
5. The researchers concluded that “although fusion is beneficial for improving health outcomes in patients with spondylolisthesis, it is not cost-effective when analyzing a one-year timeframe based on the threshold.”
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