Cost-Utility Analysis of Surgery and Radiotherapy for Symptomatic Spinal Metastases in a Belgian Specialist Center

OBJECTIVE: Spinal metastases represent the most common site of bony metastases and frequently reduce quality of life. A beneficial effect of surgery and radiotherapy versus radiotherapy alone has been demonstrated in symptomatic patients. The goal of our study was to perform a cost-utility analysis of surgery for spinal metastases based on patient-level costs and health status data in a specialist spine center in Belgium. METHODS: A cost-utility analysis was performed in a prospective cohort of patients undergoing surgery for symptomatic spinal metastases in 2011-2015. EQ-5D-3L measure of health-related quality of life data were collected preoperatively and at 3, 6, 12, and 24 months. Hospital costs relating to surgical management including postoperative radiotherapy were analyzed. A retrospective cohort of patients treated with radiotherapy alone between 2011 and 2015, which matched the surgical patients for disease load and presentation, also was assessed. Quality-adjusted life years (QALYs) for nonsurgical patients were modelled against the surgical group. RESULTS: In total, 38 consecutive surgical patients had information for cost-utility analysis and 8 nonsurgical patients were matched. Mean total cost in the surgical group was (sic)16,989 (SD (sic)8148), largely comprising nonmedical staffing cost (mean (sic)7721, 45.9%), followed by daily operational costs ((sic)2963, 17.6%) and medical staffing costs ((sic)2621, 15.6%). Median initial health status was 0.33 (interquartile range 0.15-0.55), and median postoperative QALYs were 0.70 (interquartile range 0.18-1.70). Mean total cost in the nonsurgical cohort was (sic)9354. The incremental cost-effectiveness ratio for surgical management was (sic)13,635 (range (sic)12,726-(sic)14,407) per QALY. CONCLUSIONS: Surgery for symptomatic spinal metastases in a specialist hospital in Belgium is cost-effective.