Is Early Surgical Decompression for Traumatic Cervical Spinal Cord Injury (SCI) Feasible and Cost-Effective? (S47.003)

Abstract

Objective: This study compares early (≤24 hours since SCI) versus later surgical decompression of spinal cord in order to determine which approach is more cost effective in the management of patients with acute cervical SCI and to examine the potential barriers and ideal timelines for each step to early surgical decompression. Background Pre-clinical and clinical studies suggest that early surgery is potentially beneficial. Design/Methods: A cost-utility analysis was performed using data for the first year after cervical SCI. The perspective of a public health care insurer was adopted. Utilities are from the Surgical Trial in Acute SCI Study. The reasons for delays in the management steps were classified into: (a) healthcare-related (“extrinsic”) and (b) patient-related (“intrinsic”) factors. Results: When considering the late decompression as the baseline strategy, the incremental cost-effectiveness ratio is US$8,523,852 per quality-adjusted life year (QALY) for patients with complete SCI and US$275,390/QALY for patients with incomplete SCI. The probabilistic analysis indicated that there is no clearly dominant strategy. While patients who underwent early surgery had a significantly shorter time period associated with extrinsic factors than individuals who underwent later surgery (19.16 versus 71.28 hours), both groups were comparable regarding time periods related to intrinsic factors. Conclusions: The results of our economic analysis suggests that, although no strategy is clearly superior to the other, early decompression of spinal cord can be more cost effective than delayed surgery in approximately one quarter of the patients with complete SCI and one third of the individuals with incomplete SCI. Our benchmarking analysis suggests that health-related factors are key determinants of the timing from SCI to spinal cord decompression. Time in the general hospital and time of waiting for surgical decision were the most important causes of delays for surgery. Early surgery is feasible in the vast majority of the cases. Supported by: Funded by the Rick Hansen Foundation. Disclosure: Dr. Furlan has nothing to disclose. Dr. Fehlings has received personal compensation for activities with Depuy Spine as a consultant.