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Minimally Invasive Spine Surgery pp 29–40Cite as

Economics of Minimally Invasive Spine Surgery

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Abstract

Due to increasing cost, healthcare 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. For clinicians to contribute to healthcare 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-to-moderate 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, one economic 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 healthcare utilization, and perhaps most importantly the difference in indirect cost such as return to activity (i.e., productivity) of MIS versus open spine surgery will support a broader adoption of minimally invasive spine surgery.

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Author information

Authors and Affiliations

  1. University Health Network, Toronto Western Hospital, University of Toronto, Department of Surgery, Division of Orthopaedics, Toronto, ON, Canada

    Robert A. Ravinsky & Y. Raja Rampersaud

Authors
  1. Robert A. Ravinsky
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  2. Y. Raja Rampersaud
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Corresponding author

Correspondence to Y. Raja Rampersaud .

Editor information

Editors and Affiliations

  1. Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA

    Frank M. Phillips

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

    Isador H. Lieberman

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

    David W. Polly Jr.

  4. Department of Neurological Surgery, University of Miami/Jackson Memorial Hospital, Miami, FL, USA

    Michael Y. Wang

Appendices

Quiz Questions

  1. 1.

    Which of the following would be considered a cost-minimization study?

    1. (a)

      A study comparing the costs associated with two different interventions.

    2. (b)

      A study comparing the costs associated with two different interventions, in whom the clinical outcomes have been consistently demonstrated to be different.

    3. (c)

      A study comparing the costs associated with two different interventions, in whom the clinical outcomes have been consistently demonstrated to be the same.

    4. (d)

      A study comparing two different interventions, which takes into account both costs and clinical effectiveness.

  2. 2.

    Which of the following scenarios would be most appropriate for a CEA?

    1. (a)

      Intervention A is more costly and more effective than intervention B.

    2. (b)

      Intervention A is more costly and less effective than intervention B.

    3. (c)

      Intervention A is less costly and more effective than intervention B.

    4. (d)

      Intervention A is more costly than intervention B, and the outcomes have been demonstrated to be equivalent.

  3. 3.

    Which of the following is an example of an indirect cost associated with an intervention?

    1. (a)

      In-hospital, transfusion-related costs

    2. (b)

      The lost work days incurred by the spouse of a patient, in order to care for that individual, post-discharge.

    3. (c)

      The cost of outpatient rehabilitation, post-discharge.

    4. (d)

      The costs related to treating a postoperative pulmonary embolus.

  4. 4.

    True or false: Generally, implant-related costs are greater in MISS compared to open spine surgery.

  5. 5.

    True or false: There exists an abundance of scholarship that has carefully studied the indirect costs of spinal surgery, both MIS and open.

Answers

  1. 1.

    c

  2. 2.

    a

  3. 3.

    b

  4. 4.

    True

  5. 5.

    False

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Ravinsky, R.A., Rampersaud, Y.R. (2019). Economics of Minimally Invasive Spine Surgery. In: Phillips, F., Lieberman, I., Polly Jr., D., Wang, M. (eds) Minimally Invasive Spine Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-19007-1_3

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