Table 2.
Adjusted Mean Quality-Adjusted Life-Years (QALYs) and Costs (95% CIs) over 2 Years*
| Outcome | Patients with Spinal Stenosis |
Patients with Degenerative Spondylolisthesis with Spinal Stenosis |
||
|---|---|---|---|---|
| Surgery (n = 394) | Nonoperative Management (n = 240) | Surgery (n = 368) | Nonoperative Management (n = 233) | |
| Cost-effectiveness | ||||
| QALYs† | 1.54 (1.51 to 1.56) | 1.37 (1.33 to 1.40) | 1.55 (1.53 to 1.58) | 1.33 (1.30 to 1.36) |
| Direct costs, $ | ||||
| Surgery mean cost‡ | 10 635 (9798 to 11 472) | – | 23 087 (22 415 to 23 759) | – |
| Health care visits§ | 2262 (1986 to 2538) | 2176 (1886 to 2466) | 2407 (2124 to 2690) | 2169 (1884 to 2453) |
| Diagnostic tests|| | 976 (678 to 1273) | 1376 (1064 to 1688) | 967 (724 to 1211) | 975 (732 to 1218) |
| Medications|| | 1972 (1711 to 2232) | 2273 (1998 to 2548) | 2070 (1796 to 2344) | 2503 (2227 to 2779) |
| Other health care services¶ | 2188 (1458 to 2918) | 1416 (650 to 2181) | 3378 (2829 to 3926) | 1057 (506 to 1608) |
| Total direct costs** | 17 688 (16 465 to 18 912) | 7161 (5871 to 8450) | 31 938 (30 806 to 33 070) | 6906 (5765 to 8048) |
| Indirect costs, $ | ||||
| Work loss|| | 2276 (1705 to 2847) | 1585 (985 to 2185) | 2208 (1698 to 2719) | 993 (482 to 1504) |
| Unpaid caregivers|| | 281 (111 to 452) | 268 (90 to 447) | 610 (431 to 788) | 71 (−108 to 250) |
| Missed homemaking|| | 4668 (3323 to 6012) | 5681 (4268 to 7094) | 7706 (6117 to 9295) | 7794 (6198 to 9390) |
| Total indirect costs** | 7056 (5604 to 8509) | 7401 (5874 to 8928) | 10 472 (8803 to 12 140) | 8942 (7267 to 10 617) |
| Total costs, $†** | 26 222 (24 308 to 28 129) | 13 519 (10 921 to 15 796) | 42 081 (39 800 to 44 373) | 16 046 (13 862 to 18 234) |
Baseline covariates used for spinal stenosis models were age, sex, comorbid stomach conditions, straight leg raise or femoral tension sign, smoking status, comorbid joint conditions, patient self-assessed health trend, annual income, compensation, body mass index, baseline EuroQol EQ-5D score, and center. Baseline covariates used for degenerative spondylolisthesis models were age, sex, work status, depression, osteoporosis, joint problems, current symptom duration, reflex deficit, number of moderate or severe stenotic levels, baseline EuroQol EQ-5D score, baseline stenosis bothersomeness, and center.
Means and CIs are based on longitudinal models with bootstrap sampling.
Includes surgeon costs, anesthesiology costs, and hospitalization costs, which were estimated for both the Medicare and general adult populations.
Includes all health care visits within the recall period.
Limited to spine problem–related use or work/homemaking loss.
Includes all emergency department visits or hospitalizations and spine-related use of medical devices, injections, paid caregivers, and rehabilitation.
The sum of the components does not equal the total cost because the estimate is based on data aggregated at the level of the individual in adjusted, as-treated analyses.