{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T22:19:10Z","timestamp":1780438750188,"version":"3.54.1"},"reference-count":40,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["SPI"],"published-print":{"date-parts":[[2016,6]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Transforaminal lumbar interbody fusion (TLIF) has become the most commonly used fusion technique for lumbar degenerative disorders. This suggests an expectation of better clinical outcomes with this technique, but this has not been validated consistently. How surgical variables and choice of health utility measures drive the cost-effectiveness of TLIF relative to posterolateral fusion (PSF) has not been established. The authors used health utility values derived from Short Form-6D (SF-6D) and EQ-5D and different cost-effectiveness thresholds to evaluate the relative cost-effectiveness of TLIF compared with PSF.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>From the National Neurosurgery Quality and Outcomes Database (N<jats:sup>2<\/jats:sup>QOD), 101 patients with spondylolisthesis who underwent PSF were propensity matched to patients who underwent TLIF. Health-related quality of life measures and perioperative parameters were compared. Because health utility values derived from the SF-6D and EQ-5D questionnaires have been shown to vary in patients with low-back pain, quality-adjusted life years (QALYs) were derived from both measures. On the basis of these matched cases, a sensitivity analysis for the relative cost per QALY of TLIF versus PSF was performed in a series of cost-assumption models.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>Operative time, blood loss, hospital stay, and 30-day and 90-day readmission rates were similar for the TLIF and PSF groups. Both TLIF and PSF significantly improved back and leg pain, Oswestry Disability Index (ODI) scores, and EQ-5D and SF-6D scores at 3 and 12 months postoperatively. At 12 months postoperatively, patients who had undergone TLIF had greater improvements in mean ODI scores (30.4 vs 21.1, p = 0.001) and mean SF-6D scores (0.16 vs 0.11, p = 0.001) but similar improvements in mean EQ-5D scores (0.25 vs 0.22, p = 0.415) as patients treated with PSF. At a cost per QALY threshold of $100,000 and using SF-6D\u2013based QALYs, the authors found that TLIF would be cost-prohibitive compared with PSF at a surgical cost of $4830 above that of PSF. However, with EQ-5D\u2013based QALYs, TLIF would become cost-prohibitive at an increased surgical cost of $2960 relative to that of PSF. With the 2014 US per capita gross domestic product of $53,042 as a more stringent cost-effectiveness threshold, TLIF would become cost-prohibitive at surgical costs $2562 above that of PSF with SF-6D\u2013based QALYs or at a surgical cost exceeding that of PSF by $1570 with EQ-5D\u2013derived QALYs.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>As with all cost-effectiveness studies, cost per QALY depended on the measure of health utility selected, durability of the intervention, readmission rates, and the accuracy of the cost assumptions.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2015.10.spine15917","type":"journal-article","created":{"date-parts":[[2016,2,19]],"date-time":"2016-02-19T15:01:49Z","timestamp":1455894109000},"page":"916-921","source":"Crossref","is-referenced-by-count":27,"title":["Modeled cost-effectiveness of transforaminal lumbar interbody fusion compared with posterolateral fusion for spondylolisthesis using N2QOD data"],"prefix":"10.3171","volume":"24","author":[{"given":"Leah Y.","family":"Carreon","sequence":"first","affiliation":[{"name":"Norton Leatherman Spine Center, Louisville, Kentucky;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven D.","family":"Glassman","sequence":"additional","affiliation":[{"name":"Norton Leatherman Spine Center, Louisville, Kentucky;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zoher","family":"Ghogawala","sequence":"additional","affiliation":[{"name":"Alan and Jacqueline Stuart Spine Center, Department of Neurosurgery, Lahey Hospital and Medical Center, Burlington, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Praveen V.","family":"Mummaneni","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco, California; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew J.","family":"McGirt","sequence":"additional","affiliation":[{"name":"Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony L.","family":"Asher","sequence":"additional","affiliation":[{"name":"Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-spine15917","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"2351","DOI":"10.1097\/BRS.0b013e3181b8a829","article-title":"Degenerative spondylolisthesis: does fusion method influence outcome? Four-year results of the spine patient outcomes research trial","volume":"34","author":"Abdu","year":"2009"},{"issue":"22 Suppl 1","key":"b2-spine15917","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"S106","DOI":"10.1097\/BRS.0000000000000579","article-title":"The National Neurosurgery Quality and Outcomes Database (N2QOD): a collaborative North American outcomes registry to advance value-based spine care","volume":"39","author":"Asher","year":"2014"},{"key":"b3-spine15917","series-title":"Singapore Med J","first-page":"183","article-title":"Comparison of clinical and radiological results of posterolateral fusion, posterior lumbar interbody fusion and transforaminal lumbar interbody fusion techniques in the treatment of degenerative lumbar spine","volume":"53","author":"Audat","year":"2012"},{"key":"b4-spine15917","series-title":"J Health Serv Res Policy","doi-asserted-by":"publisher","first-page":"174","DOI":"10.1177\/135581969900400310","article-title":"A review of the use of health status measures in economic evaluation","volume":"4","author":"Brazier","year":"1999"},{"key":"b5-spine15917","series-title":"J Health Econ","doi-asserted-by":"publisher","first-page":"271","DOI":"10.1016\/S0167-6296(01)00130-8","article-title":"The estimation of a preference-based measure of health from the SF-36","volume":"21","author":"Brazier","year":"2002"},{"key":"b6-spine15917","series-title":"Health Econ","doi-asserted-by":"publisher","first-page":"873","DOI":"10.1002\/hec.866","article-title":"A comparison of the EQ-5D and SF-6D across seven patient groups","volume":"13","author":"Brazier","year":"2004"},{"key":"b7-spine15917","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"2085","DOI":"10.1097\/BRS.0b013e3181a93ea6","article-title":"Predicting SF-6D utility scores from the Oswestry disability index and numeric rating scales for back and leg pain","volume":"34","author":"Carreon","year":"2009"},{"key":"b8-spine15917","series-title":"Eur Spine J","doi-asserted-by":"publisher","first-page":"1137","DOI":"10.1007\/s00586-014-3238-6","article-title":"Transforaminal lumbar interbody fusion vs posterolateral instrumented fusion: cost-utility evaluation along side an RCT with a 2-year follow-up","volume":"23","author":"Christensen","year":"2014"},{"key":"b9-spine15917","series-title":"Stat Med","doi-asserted-by":"publisher","first-page":"2265","DOI":"10.1002\/(SICI)1097-0258(19981015)17:19<2265::AID-SIM918>3.0.CO;2-B","article-title":"Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group","volume":"17","author":"D'Agostino","year":"1998"},{"key":"b10-spine15917","series-title":"Acta Orthop Belg","first-page":"578","article-title":"Posterolateral versus interbody fusion in isthmic spondylolisthesis: functional results in 52 cases with a minimum follow-up of 6 years","volume":"70","author":"Dehoux","year":"2004"},{"key":"b11-spine15917","series-title":"Methods for the Economic Evaluation of Health Care Programmes","author":"Drummond","year":"2005"},{"key":"b12-spine15917","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"2178","DOI":"10.1097\/BRS.0b013e31814b1bd8","article-title":"Posterior lumbar interbody fusion versus posterolateral fusion in adult isthmic spondylolisthesis","volume":"32","author":"Ekman","year":"2007"},{"key":"b13-spine15917","series-title":"Health Policy","doi-asserted-by":"publisher","first-page":"199","DOI":"10.1016\/0168-8510(90)90421-9","article-title":"EuroQol\u2014a new facility for the measurement of health-related quality of life","volume":"16","author":"EuroQol Group","year":"1990"},{"key":"b14-spine15917","series-title":"Physiotherapy","first-page":"271","article-title":"The Oswestry low back pain disability questionnaire","volume":"66","author":"Fairbank","year":"1980"},{"key":"b15-spine15917","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"2940","DOI":"10.1097\/00007632-200011150-00017","article-title":"The Oswestry Disability Index","volume":"25","author":"Fairbank","year":"2000"},{"key":"b16-spine15917","series-title":"J Neurotrauma","doi-asserted-by":"publisher","first-page":"1567","DOI":"10.1089\/neu.2011.2167","article-title":"Posterolateral versus posterior interbody fusion in isthmic spondylolisthesis","volume":"29","author":"Farrokhi","year":"2012"},{"key":"b17-spine15917","series-title":"Cost-Effectiveness in Health and Medicine","author":"Gold","year":"1996"},{"key":"b18-spine15917","series-title":"J Spinal Disord Tech","doi-asserted-by":"publisher","first-page":"229","DOI":"10.1097\/BSD.0b013e3180eaa202","article-title":"Comparison of posterolateral fusion with and without additional posterior lumbar interbody fusion for degenerative lumbar spondylolisthesis","volume":"21","author":"Ha","year":"2008"},{"key":"b19-spine15917","series-title":"J Spinal Disord","doi-asserted-by":"publisher","first-page":"533","DOI":"10.1097\/00002517-200112000-00013","article-title":"Anterior\/posterior lumbar fusion versus transforaminal lumbar interbody fusion: analysis of complications and predictive factors","volume":"14","author":"Hee","year":"2001"},{"key":"b20-spine15917","series-title":"Eur Spine J","doi-asserted-by":"publisher","first-page":"2022","DOI":"10.1007\/s00586-013-2760-2","article-title":"Transforaminal lumbar interbody fusion (TLIF) versus posterior instrumented fusion (PLF) in degenerative lumbar disorders: A randomized clinical trial with 2-year follow-up","volume":"22","author":"H\u00f8y","year":"2013"},{"key":"b21-spine15917","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"567","DOI":"10.1097\/00007632-200103010-00023","article-title":"Comparison of posterior and transforaminal approaches to lumbar interbody fusion","volume":"26","author":"Humphreys","year":"2001"},{"key":"b22-spine15917","series-title":"BMJ","doi-asserted-by":"publisher","first-page":"736","DOI":"10.1136\/bmj.316.7133.736","article-title":"Variations in population health status: results from a United Kingdom national questionnaire survey","volume":"316","author":"Kind","year":"1998"},{"key":"b23-spine15917","series-title":"Pain: A Clinical Manual for Nursing Practice","author":"McCaffery","year":"1993"},{"key":"b24-spine15917","series-title":"Qual Life Res","doi-asserted-by":"publisher","first-page":"1321","DOI":"10.1007\/s11136-004-5743-2","article-title":"Comparison of EQ-5D, HUI, and SF-36-derived societal health state values among spine patient outcomes research trial (SPORT) participants","volume":"14","author":"McDonough","year":"2005"},{"key":"b25-spine15917","series-title":"Med Decis Making","doi-asserted-by":"publisher","first-page":"270","DOI":"10.1177\/0272989X10380924","article-title":"A longitudinal comparison of 5 preference-weighted health state classification systems in persons with intervertebral disk herniation","volume":"31","author":"McDonough","year":"2011"},{"issue":"22 Suppl 1","key":"b26-spine15917","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"S117","DOI":"10.1097\/BRS.0000000000000552","article-title":"Role of prospective registries in defining the value and effectiveness of spine care","volume":"39","author":"McGirt","year":"2014"},{"issue":"1","key":"b27-spine15917","series-title":"Neurosurg Focus","doi-asserted-by":"publisher","first-page":"E6","DOI":"10.3171\/2012.10.FOCUS12297","article-title":"The National Neurosurgery Quality and Outcomes Database (N2QOD): general overview and pilot-year project description","volume":"34","author":"McGirt","year":"2013"},{"key":"b28-spine15917","series-title":"Surg Gynecol Obstet","first-page":"371","article-title":"Spondylolisthesis","volume":"54","author":"Meyerding","year":"1931"},{"key":"b29-spine15917","series-title":"Spine J","doi-asserted-by":"publisher","first-page":"1719","DOI":"10.1016\/j.spinee.2013.10.014","article-title":"Trends in the surgical treatment of lumbar spine disease in the United States","volume":"15","author":"Pannell","year":"2015"},{"key":"b30-spine15917","series-title":"J Spinal Disord Tech","doi-asserted-by":"publisher","first-page":"337","DOI":"10.1097\/01.bsd.0000166642.69189.45","article-title":"Transforaminal lumbar interbody fusion: clinical and radiographic results and complications in 100 consecutive patients","volume":"18","author":"Potter","year":"2005"},{"key":"b31-spine15917","series-title":"J Am Stat Assoc","doi-asserted-by":"publisher","first-page":"387","DOI":"10.1080\/01621459.1987.10478441","article-title":"Model-based direct adjustment","volume":"82","author":"Rosenbaum","year":"1987"},{"key":"b32-spine15917","series-title":"Med Care","doi-asserted-by":"publisher","first-page":"889","DOI":"10.1097\/MLR.0b013e3181a39428","article-title":"Comparing cost-utility estimates: does the choice of EQ-5D or SF-6D matter?","volume":"47","author":"Sach","year":"2009"},{"key":"b33-spine15917","series-title":"Value Health","doi-asserted-by":"publisher","first-page":"606","DOI":"10.1111\/j.1524-4733.2008.00466.x","article-title":"Interchangeability of the EQ-5D and the SF-6D in long-lasting low back pain","volume":"12","author":"S\u00f8gaard","year":"2009"},{"key":"b34-spine15917","series-title":"Ann Intern Med","doi-asserted-by":"publisher","first-page":"845","DOI":"10.7326\/0003-4819-149-12-200812160-00003","article-title":"Surgical treatment of spinal stenosis with and without degenerative spondylolisthesis: cost-effectiveness after 2 years","volume":"149","author":"Tosteson","year":"2008"},{"key":"b35-spine15917","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"2108","DOI":"10.1097\/BRS.0b013e318182e390","article-title":"The cost effectiveness of surgical versus nonoperative treatment for lumbar disc herniation over two years: evidence from the Spine Patient Outcomes Research Trial (SPORT)","volume":"33","author":"Tosteson","year":"2008"},{"key":"b36-spine15917","series-title":"Chin Med Sci J","first-page":"41","article-title":"Outcome of posterolateral fusion versus circumferential fusion with cage for lumbar stenosis and low degree lumbar spondylolisthesis","volume":"21","author":"Wang","year":"2006"},{"key":"b37-spine15917","series-title":"Med Care","doi-asserted-by":"publisher","first-page":"473","DOI":"10.1097\/00005650-199206000-00002","article-title":"The MOS 36-Item Short Form Health Survey (SF-36). I Conceptual framework and item selection","volume":"30","author":"Ware","year":"1992"},{"key":"b38-spine15917","series-title":"Med Decis Making","doi-asserted-by":"publisher","first-page":"417","DOI":"10.1177\/027298902320556118","article-title":"Health economic evaluations: the special case of end-stage renal disease treatment","volume":"22","author":"Winkelmayer","year":"2002"},{"key":"b39-spine15917","series-title":"Macroeconomics and Health: Investing in Health for Economic Development: Report of the Commission on Macroeconomics and Health","author":"World Health Organization","year":"2001"},{"key":"b40-spine15917","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"295","DOI":"10.3171\/2011.4.SPINE10330","article-title":"Meta-analysis of instrumented posterior interbody fusion versus instrumented posterolateral fusion in the lumbar spine","volume":"15","author":"Zhou","year":"2011"}],"container-title":["Journal of Neurosurgery: Spine"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/24\/6\/article-p916.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/24\/6\/article-p916.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/24\/6\/article-p916.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,15]],"date-time":"2023-04-15T21:57:22Z","timestamp":1681595842000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/24\/6\/article-p916.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,6]]},"references-count":40,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.3171\/2015.10.spine15917","relation":{},"ISSN":["1547-5654"],"issn-type":[{"value":"1547-5654","type":"print"}],"subject":[],"published":{"date-parts":[[2016,6]]}}}