Is there enough strong evidence to prove minimal access spine surgery is more cost-effective than traditional open procedures?
A study published in Spine examined this question for both cervical and lumber procedures. The researchers examined publications comparing less invasive procedures to the conventional open technique. They identified full economic studies comparing the two procedures published prior to Dec. 24, 2013.
There were six articles that met the inclusion criteria, all for lumbar procedures. None of the studies for the cervical spine met the criteria. The researchers found:
1. There were no significant differences in cost-effectiveness between open surgery and minimal access surgery for the lumbar spine.
2. A bulk of the evidence lacked details on methodology for modeling, related assumptions, economic justification for the models chosen and sources and types of included costs and consequences.
3. Follow-up periods were variable and indirect costs were not analyzed or reported frequently within the examined body of literature.
4. Many of the studies were conducted by a single group, which limits generalizability.
5. Any conclusions drawn from the studies are considered preliminary because "there was a paucity of high-quality evidence."
"Prospective studies are needed to define differences and optimal treatment algorithms," concluded the study authors. The authors of a second article published in the same edition of Spine examine the role of decision analytic modeling in spinal intervention health economic assessments.
"A proper integrated, clinical and economic critical appraisal is necessary in the evaluation of the strength of evidence provided by a modeling evaluation. As is the case with clinical research, all options for collecting health economic or value data are not without their limitations and flaws," the study authors wrote in the abstract.
That study found most cost-effectiveness results in spine surgery are based on the $100,000 per quality-adjusted life-year threshold and recommend spine care providers partner with health economic professionals to provide perspective to current health economic models and eventually healthcare policy.