112?Development of a Novel Quality of Life Utility Index Using NDI and VAS in Patients With Multi-Level Cervical Spondylosis.

112?Development of a Novel Quality of Life Utility Index Using NDI and VAS in Patients With Multi-Level Cervical Spondylosis.

Neurosurgery. 2013 Aug;60 Suppl 1:157

Authors: Ament JD, Yang Z, Kim KD

Abstract
INTRODUCTION: Cervical total disc replacement (TDR) was developed to treat neck pain and neurological sequelae associated with cervical spondylosis, while preserving motion. While ACDF has been the standard of care, a recent randomized controlled trial (RCT) 1 suggested similar outcomes for 2-level disease. However, the quality of life benefit in this population, afforded by both TDR and ACDF, has never been fully elucidated. The purpose of our investigation was to better define the changes in utility and perceived value for patients undergoing these procedures.
METHODS: Data was derived from LDR's RCT1. Included patients (n = 330) had degenerative disc disease with radiculopathy/myeloradiculopathy at 2 contiguous levels from C3-C7 that was unresponsive to conservative treatment. Using linear regression, we constructed health states based on the stratification of clinical outcomes used in the RCT, namely, neck disability index (NDI) and visual analog scale (VAS). Data from SF-12 questionnaires 2, completed pre-operatively and at each follow-up visit, were then transformed into utilities using the validated SF-6D mapping algorithm3. These were then compared to the previously derived health states. SAS v.9.3 was used for the analyses.
RESULTS: A strong correlation (R2 = 0.6864, P < .0001) was found between NDI and VAS. We constructed 5 distinct health states by projecting established NDI intervals onto the VAS scale. The distributions of SF-6D utility scores illustrated a clear trend with improvement in overall quality of life for all patients when comparing mean utility pre-op and at 24-months post-op (mean utility improvement = 0.206, 95%CI: 0.187-0.225, P < .0001). The mean utility value was then calculated for each health state, again highlighting a clear association between health states and utility.
CONCLUSION: To our knowledge, this is the first instance where distinct utility values have been derived for validated health states related to cervical spine disease. There is substantial potential for these to become baseline indices for future cost-utility analyses in similar populations.

PMID: 23839379 [PubMed - in process]


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