Cost-Effectiveness Analysis: Minimally Invasive Spine Surgery
Cost-Effectiveness Analysis: Minimally Invasive Spine Surgery
A literature review was performed using PubMed, the CEA Registry, and the National Health Service Economic Evaluation Database (NHS EED) to find articles evaluating the cost of MISS. Articles were excluded if the study was conducted in a health care facility outside the US or was published in a language other than English. Each article was screened for inclusion and exclusion criteria after reading the abstracts and identifying the outcomes or end points being analyzed by the authors. If there was no mention of cost, CEA/CUA, QALY, quality, or outcomes mentioned, then the article was excluded. No preference was made regarding the type of MISS performed or the area of the spine (cervical vs thoracic vs lumbar). Only papers comparing MISS with open procedures were found to have reported costs (whether direct, indirect, or total). We defined direct and indirect costs as described by Allen and Garfin and Tosteson et al. In brief, direct costs pertain to the costs of surgery, hospital stay, medications, laboratory tests/imaging, and so on during a patient's stay for surgery. Conversely, indirect costs are incurred from productivity loss as a result of the relative injury and include missed days/wages from work and missed days from homemaking. Total cost is determined to be the total of both direct and indirect costs and reflects the overall economic value of an intervention.
The literature search was performed using key words/MeSH terms to screen for papers of interest. The same set of key words was used in each database (PubMed, CEA Registry, and NHS EED): spine, spine surgery, minimally invasive spine, minimally invasive spine cost, spine QALY, and economics of minimally invasive spine. Abstracts were reviewed for the inclusion and exclusion criteria previously mentioned. Two articles were identified through NHS EED, 3 through the CEA Registry, and the other 9 through PubMed.
While reading through each paper, we focused our data collection on identifying costs (direct, indirect, and total), follow-up length, length of stay (LOS), estimated blood loss (EBL), surgery site infection (SSI), type of study, and type of MISS, if reported. The primary outcome of interest in this study is the cost of minimally invasive spine procedures. Direct, indirect, and total costs were identified and analyzed. Comparisons were made between MISS and open procedures to help determine the utility of a minimally invasive approach in regard to these outcomes. Secondary points of interest include surgical outcomes from these same approaches that are reported in the studies reviewed for cost.
Methods
Overview
A literature review was performed using PubMed, the CEA Registry, and the National Health Service Economic Evaluation Database (NHS EED) to find articles evaluating the cost of MISS. Articles were excluded if the study was conducted in a health care facility outside the US or was published in a language other than English. Each article was screened for inclusion and exclusion criteria after reading the abstracts and identifying the outcomes or end points being analyzed by the authors. If there was no mention of cost, CEA/CUA, QALY, quality, or outcomes mentioned, then the article was excluded. No preference was made regarding the type of MISS performed or the area of the spine (cervical vs thoracic vs lumbar). Only papers comparing MISS with open procedures were found to have reported costs (whether direct, indirect, or total). We defined direct and indirect costs as described by Allen and Garfin and Tosteson et al. In brief, direct costs pertain to the costs of surgery, hospital stay, medications, laboratory tests/imaging, and so on during a patient's stay for surgery. Conversely, indirect costs are incurred from productivity loss as a result of the relative injury and include missed days/wages from work and missed days from homemaking. Total cost is determined to be the total of both direct and indirect costs and reflects the overall economic value of an intervention.
Systematic Literature Review
The literature search was performed using key words/MeSH terms to screen for papers of interest. The same set of key words was used in each database (PubMed, CEA Registry, and NHS EED): spine, spine surgery, minimally invasive spine, minimally invasive spine cost, spine QALY, and economics of minimally invasive spine. Abstracts were reviewed for the inclusion and exclusion criteria previously mentioned. Two articles were identified through NHS EED, 3 through the CEA Registry, and the other 9 through PubMed.
Data Variables
While reading through each paper, we focused our data collection on identifying costs (direct, indirect, and total), follow-up length, length of stay (LOS), estimated blood loss (EBL), surgery site infection (SSI), type of study, and type of MISS, if reported. The primary outcome of interest in this study is the cost of minimally invasive spine procedures. Direct, indirect, and total costs were identified and analyzed. Comparisons were made between MISS and open procedures to help determine the utility of a minimally invasive approach in regard to these outcomes. Secondary points of interest include surgical outcomes from these same approaches that are reported in the studies reviewed for cost.
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