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Economics of Minimally Invasive Spine Surgery

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Abstract

Due to increasing cost, health-care delivery in its present state is unsustainable in many nations. A key component of health reform is the assessment of resource allocation and the active support of interventions that demonstrate the best value. In order for clinicians to contribute to health-care reform in a meaningful way, insight into the decision-making language (e.g., quality-adjusted life-year or cost per QALY gained) used by governments, payers, and policy makers is crucial. Minimally invasive surgery (MIS), which is typically associated with greater up-front cost, has demonstrated good value for techniques such as arthroscopic and laparoscopic surgery; however, the value of minimally invasive spine surgery (MISS) remains controversial. Although many types of health economic evaluations (HEEs) exist, a cost-effectiveness analysis (CEA) which simultaneously considers both the comparative clinical effectiveness and cost of intervention is the method of choice for HEE.

Current, low-quality comparative data suggest that MIS lumbar fusion provides at least equivalent clinical outcome in the midterm and consistently demonstrates quality and cost-benefits in the perioperative period compared to open fusion. The initial increase in direct cost of MIS fusion appears to be offset by the perioperative benefits which produce an overall net cost savings. Of the available literature, only one limited study has performed a CEA (cost/QALY), the results of which favored MIS fusion compared to open 1–2-level fusion. Going forward, more comprehensive HEEs comparing the outcome effect over time, ongoing medical resource utilization, and perhaps most importantly the difference in indirect cost such as return to activity (i.e., productivity) of MIS versus open spine surgery are required to support a broader adoption of MIS of the spine.

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Authors and Affiliations

  1. Division of Orthopaedics and Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada

    Y. Raja Rampersaud MD, FRCSC

  2. Division of Orthopaedics, University of Toronto, Toronto, ON, Canada

    Kevin Macwan BHSc

Authors
  1. Y. Raja Rampersaud MD, FRCSC
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  2. Kevin Macwan BHSc
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Correspondence to Y. Raja Rampersaud MD, FRCSC .

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Editors and Affiliations

  1. Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA

    Frank Phillips

  2. Scoliosis and Spine Tumor Center, Texas Back Institutes, Texas Health Presbyterian Hospital Plano, Plano, Texas, USA

    Isador Lieberman

  3. Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA

    David Polly

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Rampersaud, Y.R., Macwan, K. (2014). Economics of Minimally Invasive Spine Surgery. In: Phillips, F., Lieberman, I., Polly, D. (eds) Minimally Invasive Spine Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-5674-2_3

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  • DOI: https://doi.org/10.1007/978-1-4614-5674-2_3

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