Comparative effectiveness research in spine surgery

Current State of Health Economic Analyses for Low-Grade Glioma Management: A Systematic Review

BACKGROUND

Health economic analyses help determine the value of a medical intervention by assessing the costs and outcomes associated with it. The objective of this study was to assess the level of evidence in economic evaluations for low-grade glioma (LGG) management.

METHODS

Following the PRISMA guidelines, we conducted a systematic review of English articles in Medline, Embase, The Central Registration Depository, EconPapers, and EconLit. The results were screened, and data were extracted by 2 independent reviewers for studies reporting economic evaluations for LGG. The quality of each study was evaluated using the CHEERS (Consolidated Health Economic Evaluation Reporting Standards) checklist, the hierarchy scale developed by Cooper et al. (2005), and the Quality of Health Economic Studies instrument.

RESULTS

Three studies met our inclusion criteria. The adjusted incremental cost-effectiveness ratio (ICER) values for the included studies ranged from $3934 to $9936, but each evaluated a different aspect of LGG management. All had a good quality of reporting per the CHEERS checklist. Based on the Cooper et al. hierarchy scale, the quality of data use was lacking most for utilities. The quality of study design was scored as 82, 92, and 100 for each study using the Quality of Health Economic Studies instrument.

CONCLUSIONS

Although a limited number of economic evaluations were identified, the studies evaluated here were well designed. The interventions assessed were all considered cost-effective, but pooled analysis was not possible because of heterogeneity in the interventions assessed. Given the importance of value and cost-effectiveness in medical care, more evidence is needed in this area.

Assessment of health-related quality of life in spine treatment: conversion from SF-36 to VR-12

BACKGROUND CONTEXT

Health-related quality-of-life outcomes have been collected with the Medical Outcomes Study (MOS) Short Form 36 (SF-36) survey. Boston University School of Public Health has developed algorithms for the conversion of SF-36 to Veterans RAND 12-Item Health Survey (VR-12) Physical Component Summary (PCS) and Mental Component Summary (MCS) scores.

PURPOSE

The purpose of the present study is to investigate the conversion of the SF-36 to VR-12 PCS and MCS scores.

STUDY DESIGN

Preoperative and postoperative SF-36 were collected from patients who underwent lumbar or cervical surgery from a single surgeon between August 1998 and January 2013.

METHODS

Short Form 36 PCS and MCS scores were calculated following their original instructions. The SF-36 answers were then converted to VR-12 PCS and MCS scores following the algorithm provided by the Boston University School of Public Health. The mean score, preoperative to postoperative change, and proportions of patients who reach the minimum detectable change were compared between SF-36 and VR-12.

RESULTS

A total of 1,968 patients (1,559 lumbar and 409 cervical) had completed preoperative and postoperative SF-36. The values of the SF-36 and VR-12 mean scores were extremely similar, with score differences ranging from 0.77 to 1.82. The preoperative to postoperative improvement was highly significant (p<.001) for both SF-36 and VR-12 scores. The mean change scores were similar, with a difference of up to 0.93 for PCS and up to 0.37 for MCS. Minimum detectable change (MDC) values were almost identical for SF-36 and VR-12, with a difference of 0.12 for PCS and up to 0.41 for MCS. The proportions of patients whose change in score reached MDC were also nearly identical for SF-36 and VR-12. About 90% of the patients above SF-36 MDC were also above VR-12 MDC.

CONCLUSIONS

The converted VR-12 scores, similar to the SF-36 scores, detect a significant postoperative improvement in PCS and MCS scores. The calculated MDC values and the proportions of patients whose score improvement reach MDC are similar for both SF-36 and VR-12.

Comparative effectiveness research in spine surgery

Degenerative spine disorders are a significant cause of patient morbidity and are a prominent factor in healthcare costs in many countries. Pressure for healthcare cost control and the desire for improved outcomes have led to an expanding emphasis on evidence-based medicine methodologies in spine research. Determination of the optimal treatment paradigm for many common degenerative spinal disorders has proven difficult and comparative effectiveness research is increasingly being employed to examine these clinical dilemmas. The Swedish Spine Registry and the Registry of the Scoliosis Research Society are two of the long-standing databases compiling data for spine patients. Spine surgery professional organizations have recently taken a prominent role in assembling procedural- and diagnosis-based registries, specifically addressing therapeutic outcomes for spine patients. As healthcare systems continue to evolve, comparative effectiveness research driven by spine registries may better elucidate the appropriate clinical choices for patients with these challenging illnesses.