Tag: Quality-adjusted life-years

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How much do patients benefit in quality of life after surgery for cervical spondylotic myelopathy? A Spine CORe™ analysis of QOD data

Neurosurg Focus 60(5):E2, 2026

This multicenter Quality Outcomes Database analysis evaluates long-term quality of life after surgery for cervical spondylotic myelopathy (CSM), using EQ-5D scores at baseline and 3, 12, 24, and 60 months. The study reports significant, durable postoperative EQ-5D improvements and a mean gain of 0.72 QALYs at five years across a large surgical cohort.

The analysis identifies predictors of clinically meaningful improvement: worse baseline EQ-5D increased odds of improvement, while greater baseline neck pain severity and undergoing anterior cervical corpectomy and fusion (ACCF) decreased those odds. Complication and mortality rates were low, supporting sustained quality-of-life benefits of CSM surgery.

Objective Assess long-term postoperative quality-of-life benefit after surgery for cervical spondylotic myelopathy (CSM) and identify factors linked to meaningful improvement.

Methods Post hoc analysis of a prospectively collected, 14-site QOD CSM cohort using EQ-5D at baseline and 3, 12, 24, and 60 months; MCID for EQ-5D defined as 0.11; multivariable logistic regression used to find predictors of 60-month MCID achievement.

Cohort At 60 months, follow-up status was available for 895/1085 patients (82.4%); 788 patients had 60-month EQ-5D data for the main EQ-5D analysis.

Quality-of-life gains Mean EQ-5D improved from 0.58 ± 0.22 preop to 0.76 ± 0.22 at 60 months (p < 0.001), with improvements evident by 3 months and sustained through 5 years.

Clinically meaningful benefit 58.7% of patients achieved the EQ-5D MCID at 60 months.

Negative predictors Greater baseline neck pain severity and undergoing ACCF (anterior cervical corpectomy and fusion) were independently associated with lower odds of achieving the 60-month EQ-5D MCID.

Positive predictor Worse baseline quality of life (lower baseline EQ-5D) was associated with increased odds of achieving long-term (60-month) MCID improvement.

QALYs Mean gain after surgery was 0.72 ± 1.11 QALYs over 60 months (calculated via area-under-the-curve with baseline-projected QALYs subtracted).

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A Pilot Cost-Effectiveness Analysis of Treatments in Newly Diagnosed High-Grade Gliomas: The Example of 5-Aminolevulinic Acid Compared With White-Light Surgery

5-ALA-induced fluorescence behavior of reactive tissue changes following glioblastoma treatment with radiation and chemotherapy

Neurosurgery 76:552–562, 2015

High-grade gliomas are aggressive, incurable tumors characterized by extensive diffuse invasion of the normal brain parenchyma. Novel therapies at best prolong survival; their costs are formidable and benefit is marginal. Economic restrictions thus require knowledge of the cost-effectiveness of treatments. Here, we show the cost-effectiveness of enhanced resections in malignant glioma surgery using a well-characterized tool for intraoperative tumor visualization, 5-aminolevulinic acid (5-ALA).

OBJECTIVE: To evaluate the cost-effectiveness of 5-ALA fluorescence-guided neurosurgery compared with white-light surgery in adult patients with newly diagnosed high-grade glioma, adopting the perspective of the Portuguese National Health Service.

METHODS: We used a Markov model (cohort simulation). Transition probabilities were estimated with the use of data from 1 randomized clinical trial and 1 noninterventional prospective study. Utility values and resource use were obtained from published literature and expert opinion. Unit costs were taken from official Portuguese reimbursement lists (2012 values). The health outcomes considered were quality-adjusted life-years, lifeyears, and progression-free life-years. Extensive 1-way and probabilistic sensitivity analyses were performed.

RESULTS: The incremental cost-effectiveness ratios are below €10 000 in all evaluated outcomes, being around €9100 per quality-adjusted life-year gained, €6700 per life-year gained, and €8800 per progression-free life-year gained. The probability of 5-ALA fluorescence-guided surgery cost-effectiveness at a threshold of €20000 is 96.0% for quality-adjusted life-year, 99.6% for life-year, and 98.8% for progression-free life-year.

CONCLUSION: 5-ALA fluorescence-guided surgery appears to be cost-effective in newly diagnosed high-grade gliomas compared with white-light surgery. This example demonstrates cost-effectiveness analyses for malignant glioma surgery to be feasible on the basis of existing data.

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