Abstract
BACKGROUND CONTEXT Recent studies have shown teriparatide therapy reduces the risk of proximal junctional kyphosis/failure (PJK/PJF) and subsequent revision after corrective surgery for adult spinal deformity (ASD). However, teriparatide usually costs more than other anti-osteoporotic treatments and its cost effectiveness for the prevention of these unfavorable sequelae is unclear. PURPOSE The aim of this study is to investigate the cost effectiveness of preoperative teriparatide therapy for ASD patients utilizing a Markov model of ASD corrective surgery. STUDY DESIGN/SETTING An economic decision-analysis based on a Markov model simulation. PATIENT SAMPLE A thorectical cohort of patients with adult spinal deformity patients who undergo corrective surgery. OUTCOME MEASURES Cost/QALY and the rates of patients who successfully achieved fusion without any correction loss due to PJK/PJF. METHODS A Markov model of ASD surgery was created incorporating the incidences of PJK/PJF and revision rates due to PJK/PJF in the surgically treated ASD patient with or without 12-month teriparatide treatment, revision rates for non-PJK causes, recurrence rates of PJK/PJF, postoperative mortality, and pre-/postoperative quality-adjusted life-years (QALYs), obtained from previously published literature. The effectiveness was measured in cost/QALY and the rates of patients who successfully achieved fusion without any correction loss due to PJK/PJF in each group. RESULTS The Markov model simulation showed that the 10-year cumulative cost was higher in the teriparatide group ($131,000 vs $83,000). The percentage of patients without correction loss at 10 years after surgery was also higher in the teriparatide group (86.9% vs 76.7%). The 10-year average QALYs of each group were 0.59 in the no teriparatide group and 0.61 in the teriparatide group. The cost-effectiveness of 12-month teriparatide therapy measured in cost/QALY was $213,000/QALY, which was almost twice as high as the commonly used cost-effectiveness threshold ($100,000/QALY). Teriparatide therapy can be considered as cost-effective only if teriparatide therapy less than 6 months is as effective as 12 months of treatment for PJK/PJF prevention, or teriparatide is administrated only for high-risk patients whose 24-month PJK/PJF incidence rate exceeds approximately 40% without teriparatide ($94000/QALY). CONCLUSIONS The results of our Markov model simulation suggest that teriparatide therapy is associated with lower correction loss, but is not a cost-effective option if it is routinely administered in all ASD patients regardless of bone status. Careful selection of high-risk patients for teriparatide therapy is warranted as a more cost-effective measure. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.
Published Version
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