Determining the Cost-Utility of Immediate Reconstruction in Patients with Spinal Tumors and Instrumentation
Alexander F. Mericli, M.D.
Assistant Professor of Plastic Surgery M.D. Anderson Cancer Center
Utility is the value or relative preference assigned to a health state on a scale from 0 (death) to 100 (perfect health). It is important for calculating Quality-Adjusted Life Years (QALY) and other variables found in a cost-utility analysis. We would like you to estimate the utility of a male or female patient with a primary bone tumor who must undergo a partial vertebrectomy and posterior spinal
instrumentation and fusion with immediate soft tissue reconstruction using a pedicled muscle flap.
Please use the attached visual analog scale as a reference for determining your utility scores.
Utility Questions
1. For this patient undergoing a partial vertebrectomy and immediate soft tissue reconstruction, what is the utility score of having a successful operation? (Give us a number on how a patient feels from 0-100 assuming that the patient has fully recovered from surgery and has no further signs of cancer and is living life normally)
Utility Score (0-100):
2. For this patient undergoing tumor resection via partial vertebrectomy and immediate soft tissue reconstruction, what is the utility of developing a postoperative infection necessitating antibiotics for 6 weeks? (This assumes the patient has no further signs of cancer and is fully recovered after 6 weeks of antibiotic therapy. There are no neurologic deficits or other complications.)
Utility Score (0-100):
3. For this patient undergoing tumor resection via partial vertebrectomy and immediate soft tissue reconstruction, what is the utility of the patient developing a seroma necessitating aspiration?
(This assumes the patient has no further signs of cancer and is fully recovered after drainage of the seroma. There are no neurologic deficits or other complications.)
Utility Score (0-100):
4. For this patient undergoing tumor resection via partial vertebrectomy and immediate soft tissue reconstruction, what is the utility of the patient developing a hematoma in the immediate
postoperative period necessitating a return to the operating room for drainage and washout? (This assumes the patient has no further signs of cancer and is fully recovered after washout of the hematoma. There are no neurologic deficits or other complications.)
Utility Score (0-100):
5. For this patient undergoing tumor resection via partial vertebrectomy and immediate soft tissue reconstruction, what is the utility of the patient developing a skin edge separation necessitating dressing changes for 6 weeks? (This assumes the patient has no further signs of cancer and is fully recovered after 6 weeks of dressing changes. There are no neurologic deficits or other complications.)
Utility Score (0-100):
6. For this patient undergoing tumor resection via partial vertebrectomy and immediate soft tissue reconstruction, what is the utility of the patient experiencing a total flap loss? (This assumes the patient has no further signs of cancer, but requires an additional surgery for debridement of the dead flap, placement of a new flap, and the associated donor site morbidity of a second flap.
There are no neurologic deficits or other complications.)
Utility Score (0-100):
7. For this patient undergoing tumor resection via partial vertebrectomy and immediate soft tissue reconstruction, what is the utility of the patient experiencing a partial flap loss? (This assumes the patient has no further signs of cancer, but requires an additional surgery for debridement of the partial flap loss and revision of the wound. There are no neurologic deficits or other
complications.)
Utility Score (0-100):
8. For this patient undergoing tumor resection via partial vertebrectomy and immediate soft tissue reconstruction, what is the utility of the patient developing exposure of her hardware requiring reoperation for replacement of her hardware? (This assumes the patient has no further signs of cancer, but requires an additional surgery and hospitalization in the 30 days following her tumor resection for removal of her hardware, replacement of her hardware, and reconstruction of the wound. There are no neurologic deficits or complications.)
Utility Score (0-100):
Visual-analog Health State Utility Estimation Scale
Deafness = 50.2
Total Blindness = 25.4 Hernia after TRAM flap = 66
Mild Visual Impairment = 83.6 Perfect Health = 100
Quadriplegia = 10.9
