Early Versus Delayed Surgical Decompression of Spinal Cord after Traumatic Cervical Spinal Cord Injury: A Cost-Utility Analysis

World Neurosurg. 2016 Apr;88:166-174. doi: 10.1016/j.wneu.2015.12.072. Epub 2016 Jan 7.


Objective: This cost-utility analysis was undertaken to compare early (≤24 hours since trauma) versus delayed surgical decompression of spinal cord to determine which approach is more cost effective in the management of patients with acute traumatic cervical spinal cord injury (SCI).

Methods: This study includes the patients enrolled into the Surgical Timing in Acute Spinal Cord Injury Study (STASCIS) and admitted at Toronto Western Hospital. Cases were grouped into patients with motor complete SCI and individuals with motor incomplete SCI. A cost-utility analysis was performed for each group of patients by the use of data for the first 6 months after SCI. The perspective of a public health care insurer was adopted. Costs were estimated in 2014 U.S. dollars. Utilities were estimated from the STASCIS.

Results: The baseline analysis indicates early spinal decompression is more cost-effective approach compared with the delayed spinal decompression. When we considered the delayed spinal decompression as the baseline strategy, the incremental cost-effectiveness ratio analysis revealed a saving of US$ 58,368,024.12 per quality-adjusted life years gained for patients with complete SCI and a saving of US$ 536,217.33 per quality-adjusted life years gained in patients with incomplete SCI for the early spinal decompression. The probabilistic analysis confirmed the early-decompression strategy as more cost effective than the delayed-decompression approach, even though there is no clearly dominant strategy.

Conclusions: The results of this economic analysis suggests that early decompression of spinal cord was more cost effective than delayed surgical decompression in the management of patients with motor complete and incomplete SCI, even though no strategy was clearly dominant.

Keywords: Cost-utility analysis; Costs; Economics; Rehabilitation; Spinal cord decompression; Spinal cord injury; Spine surgery; Timing; Trauma; Utility.

Publication types

  • Controlled Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Adult
  • Aged
  • Causality
  • Cervical Vertebrae / injuries*
  • Comorbidity
  • Cost-Benefit Analysis / economics
  • Decompression, Surgical / economics*
  • Decompression, Surgical / statistics & numerical data
  • Female
  • Health Care Costs / statistics & numerical data*
  • Humans
  • Male
  • Middle Aged
  • Ontario / epidemiology
  • Postoperative Complications / economics*
  • Postoperative Complications / epidemiology
  • Prevalence
  • Quality of Life
  • Retrospective Studies
  • Risk Assessment
  • Secondary Prevention / economics
  • Secondary Prevention / statistics & numerical data
  • Spinal Cord / surgery
  • Spinal Cord Injuries / economics*
  • Spinal Cord Injuries / epidemiology
  • Spinal Cord Injuries / surgery*
  • Treatment Outcome
  • United States