Acute Care and Rehabilitation Management of the Elderly with Traumatic Cervical Spinal Cord Injury: A Cost-Utility Analysis (P3.285)
Bibliographic record
Abstract
Background: The aging of the population has modified the epidemiology of traumatic spinal cord injury (SCI) as evidenced by the establishment of a bimodal distribution of injuries and increased frequency of fall-related injuries among the elderly. However, the economic implications of those changes in the epidemiology of SCI remain unclear. Objective: Given the paucity of economic studies involving elderly individuals with SCI, a cost-utility analysis (CUA) was undertaken to assess the economic impact of older age (≥65 years of age) in the context of acute care and rehabilitation management of traumatic cervical SCI. Methods: The CUA was performed under the perspective of a public health care insurer. A time horizon of 6 months post-SCI onset was used. Costs were estimated in 2014 US dollars. Utilities were generated from the Surgical Timing in Acute Spinal Cord Injury Study (STASCIS). Results: There were no significant differences between the age-related groups with regard to sex distribution, severity and level of SCI, length of stay in the acute care and rehabilitation facilities, and frequency of postoperative complications. The baseline analysis indicated that acute care and rehabilitative management of acute cervical SCI in the elderly is more costly, but similarly effective, than in younger adults. When considering acute care and rehabilitation management of younger adults with SCI as the baseline, the incremental cost-effectiveness ratio (ICER) analysis revealed an additional cost of US$ 5,655,557 per QALY gained when managing elderly patients with traumatic cervical SCI. The probabilistic analysis confirmed that spinal surgery in the elderly is more costly but similarly effective to younger adults after SCI, even though there is no definitive dominance. Conclusions: This economic analysis indicates that acute care and rehabilitation management of acute traumatic cervical SCI in the elderly is more costly but similarly effective when compared with younger adults with similar injuries.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.013 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.006 |
| Bibliometrics | 0.003 | 0.003 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.006 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".