Cost-utility Analysis of Minimally Invasive Versus Open Multilevel Hemilaminectomy for Lumbar Stenosis

Parker, Scott L.; Adogwa, Owoicho; Davis, Brandon; Fulchiero, Erin; Aaronson, Oran S.; Cheng, Joseph; Devin, Clinton J.; McGirt, Matthew J.

doi:10.1097/bsd.0b013e318232313d

Cited by 41 publications

(18 citation statements)

References 18 publications

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“…Another study by Parker et al evaluating MISS versus open multilevel hemilaminectomy showed similar results with a cost savings of $628 in direct costs and $1683 in indirect costs (> 2.5 times more savings in indirect costs). 17 This further exemplifies the impact of indirect costs in determining whether MISS is truly more cost-effective than open spine surgery and the need for more studies reporting indirect costs. Allen and Garfin discussed the potential of MISS to increase societal productivity as patients have a quicker recovery, shorter LOS, and faster return to work, which, theoretically, will all result in lower indirect costs for MISS patients and increased societal productivity.…”

Section: Discussionmentioning

confidence: 92%

Cost-effectiveness analysis in minimally invasive spine surgery

Al-Khouja¹,

Baron²,

Johnson

et al. 2014

FOC

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Object Medical care has been evolving with the increased influence of a value-based health care system. As a result, more emphasis is being placed on ensuring cost-effectiveness and utility in the services provided to patients. This study looks at this development in respect to minimally invasive spine surgery (MISS) costs. Methods A literature review using PubMed, the Cost-Effectiveness Analysis (CEA) Registry, and the National Health Service Economic Evaluation Database (NHS EED) was performed. Papers were included in the study if they reported costs associated with minimally invasive spine surgery (MISS). If there was no mention of cost, CEA, cost-utility analysis (CUA), quality-adjusted life year (QALY), quality, or outcomes mentioned, then the article was excluded. Results Fourteen studies reporting costs associated with MISS in 12,425 patients (3675 undergoing minimally invasive procedures and 8750 undergoing open procedures) were identified through PubMed, the CEA Registry, and NHS EED. The percent cost difference between minimally invasive and open approaches ranged from 2.54% to 33.68%—all indicating cost saving with a minimally invasive surgical approach. Average length of stay (LOS) for minimally invasive surgery ranged from 0.93 days to 5.1 days compared with 1.53 days to 12 days for an open approach. All studies reporting EBL reported lower volume loss in an MISS approach (range 10–392.5 ml) than in an open approach (range 55–535.5 ml). Conclusions There are currently an insufficient number of studies published reporting the costs of MISS. Of the studies published, none have followed a standardized method of reporting and analyzing cost data. Preliminary findings analyzing the 14 studies showed both cost saving and better outcomes in MISS compared with an open approach. However, more Level I CEA/CUA studies including cost/QALY evaluations with specifics of the techniques utilized need to be reported in a standardized manner to make more accurate conclusions on the cost effectiveness of minimally invasive spine surgery.

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Section: Discussionmentioning

confidence: 92%

Cost-effectiveness analysis in minimally invasive spine surgery

Al-Khouja¹,

Baron²,

Johnson

et al. 2014

FOC

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“…Furthermore, VAS pain scores were significantly lower in MIS cohorts at final follow-up. From a cost perspective, Parker et al determined that functional gain and costs were equivalent between open and MIS approaches for multilevel hemilaminectomy [20]. Quality-adjusted life years (QALYs) gained was 0.72 for both approaches, while the 2-year total cost was similar for both open ($25,420) and MIS cohorts ($23,109).…”

Section: Degenerative Spinal Stenosis: Mis Lumbar Decompressionmentioning

confidence: 99%

Minimally invasive techniques for lumbar decompressions and fusions

Narain

Hijji

Markowitz

et al. 2017

Curr Rev Musculoskelet Med

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Purpose of review The purpose of this study is to summarize the recent literature investigating the use of minimally invasive (MIS) techniques in the treatment of lumbar degenerative stenosis, spondylolisthesis, and scoliosis. Correction of sagittal alignment, however, is more variable based on current reports. Summary MIS techniques are both safe and effective in the treatment of lumbar degenerative pathologies. While some studies have reported on long-term outcomes and costs associated with MIS procedures, more investigation into these topics is still necessary. Additionally, further work is required to analyze the training requirements and learning curves of MIS procedures to better promote adoption amongst surgeons.

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“…One 11 used data from a prospective cohort. [11][12][13][14] The generalizability of included studies to broader clinical populations needs to be considered. Explicit details on economic modeling, including related assumptions and justifi cation for the economic model chosen, were rarely described.…”

Section: Study Selection and Qualitymentioning

confidence: 99%

“…One US cost-utility study 13 retrospectively compared open versus MAS multilevel hemilaminectomy in patients (n = 54) with multilevel lumbar stenosis corresponding to radicular symptoms ( Tables 2 and 3 ). There was no baseline difference between groups.…”

Section: Hemilaminectomy Of the Lumbar Spinementioning

confidence: 99%