Cost-effectiveness of three treatment strategies for XXXX : Conservative care, laminectomy, and the Superion interspinous spacer.

@entity1 @entity8848 @entity2649 @entity158 @entity479
BACKGROUND: Lumbar spinal stenosis is a @entity158 and debilitating condition resulting in healthcare costs totaling tens of billions of dollars annually. Initial treatment consists of conservative care modalities such as physical therapy, NSAIDs, opioids, and @entity479 injections. @entity1 refractory to these therapies can undergo decompressive surgery, which has good long-term efficacy but is more traumatic and can be associated with high post-operative adverse event (AE) rates. Interspinous spacers have been developed to offer a less-invasive alternative. The objective of this study was to compare the costs and quality adjusted life years (QALYs) gained of conservative care (CC) and decompressive surgery (DS) to a new minimally-invasive interspinous spacer. METHODS: A Markov model was developed evaluating 3 strategies of care for @entity2649 . If initial therapies failed, the model moved @entity1 to more invasive therapies. Data from the Superion FDA clinical trial, a prospective spinal registry, and the literature were used to populate the model. Direct medical care costs were modeled from 2014 Medicare reimbursements for healthcare services. QALYs came from the SF-12 PCS and @entity8848 components. The analysis used a 2-year time horizon with a 3% discount rate. RESULTS: CC had the lowest cost at  10,540, while Spacers and DS were nearly identical at about  13,950. CC also had the lowest QALY increase (0.06), while Spacers and DS were again nearly identical (.28). The incremental cost-effectiveness ratios (ICER) for Spacers compared to CC was  16,300 and for DS was  15,200. CONCLUSIONS: Both the Spacer and DS strategies are far below the commonly cited  50,000/QALY threshold and produced several times the QALY increase versus CC, suggesting that surgical care provides superior value (cost / effectiveness) versus sustained conservative care in the treatment of @entity2649 .
