Does aggressive treatment make benefit for patients with spinal metastasis in years lost due to disability?

Abstract

Abstract Introduction Spinal metastasis (SM) can cause pain and neurological deficits that devastate the life-quality of patients. While surgery can relieve pain and prevent neurological deficits, its high-costs and the relatively short-expected survival time raises concerns about cost-effectiveness. Therefore, this study aims to investigate whether aggressive treatment can decrease years lost due to disability (YLD) in SM patients and to identify the factors that distinguish cost-effective from non-cost-effective groups. This retrospective study included 41 patients who received aggressive treatment for SM between 2016 and 2021. We developed a worst-case model assuming that patients would only receive palliative care to assess the cost-effectiveness of aggressive treatment. We compared the YLD for each patient in the real-world scenario to those in the worst-case scenario and conducted a cost-effective analysis of medical expenses during hospital admission and one-year postoperative follow-up. The patients were divided into cost-effective and non-cost-effective groups based on cost-effectiveness definition. 13 patients were categorized as cost-effective, while 28 patients were not. The cost-effective group had better preoperative performance status (PS), lower spinal instability neoplastic score, longer predicted survival time based on the Tomita score/revised Tokuhashi score, and higher risk of deterioration based on the image study/SM location.