Methodology of economic evaluations in spine surgery: a systematic review and qualitative assessment

Abstract

ObjectivesThe present study is a systematic review conducted as part of a methodological approach to develop evidence-based recommendations for economic evaluations in spine surgery. The aim of this systematic review is to evaluate the methodology and quality of currently available clinical cost-effectiveness studies in spine surgery.Study designSystematic literature review.Data sourcesPubMed, Web of Science, Embase, Cochrane, Cumulative Index to Nursing and Allied Health Literature, EconLit and The National Institute for Health Research Economic Evaluation Database were searched through 8 December 2022.Eligibility criteria for selecting studiesStudies were included if they met all of the following eligibility criteria: (1) spine surgery, (2) the study cost-effectiveness and (3) clinical study. Model-based studies were excluded.Data extraction and synthesisThe following data items were extracted and evaluated: pathology, number of participants, intervention(s), year, country, study design, time horizon, comparator(s), utility measurement, effectivity measurement, costs measured, perspective, main result and study quality.Results130 economic evaluations were included. Seventy-four of these studies were retrospective studies. The majority of the studies had a time horizon shorter than 2 years. Utility measures varied between the EuroQol 5 dimensions and variations of the Short-Form Health Survey. Effect measures varied widely between Visual Analogue Scale for pain, Neck Disability Index, Oswestry Disability Index, reoperation rates and adverse events. All studies included direct costs from a healthcare perspective. Indirect costs were included in 47 studies. Total Consensus Health Economic Criteria scores ranged from 2 to 18, with a mean score of 12.0 over all 130 studies.ConclusionsThe comparability of economic evaluations in spine surgery is extremely low due to different study designs, follow-up duration and outcome measurements such as utility, effectiveness and costs. This illustrates the need for uniformity in conducting and reporting economic evaluations in spine surgery.

Cost-utility analysis of endoscopic lumbar discectomy following a uniform clinical pathway in the Korean national health insurance system

“…In evaluating a new surgical technique, the incurred cost to improve a unit in health outcome measurement is a common method in evaluating the technique under the health insurance system [ 35 , 36 ]. Utility measures varied between the EQ-5D and variations of the Short-Form Health Survey [ 35 ].…”

“…In evaluating a new surgical technique, the incurred cost to improve a unit in health outcome measurement is a common method in evaluating the technique under the health insurance system [ 35 , 36 ]. Utility measures varied between the EQ-5D and variations of the Short-Form Health Survey [ 35 ]. Effect measures varied widely between Visual Analogue Scale for pain, Neck Disability Index, Oswestry Disability Index, reoperation rates and adverse events [ 35 ].…”

“…Utility measures varied between the EQ-5D and variations of the Short-Form Health Survey [ 35 ]. Effect measures varied widely between Visual Analogue Scale for pain, Neck Disability Index, Oswestry Disability Index, reoperation rates and adverse events [ 35 ]. The current study used EQ-5D for cost-utility analysis.…”

Advocating uniformity in spine surgery: a practical disease-specific guideline for trial-based economic evaluations

“…Furthermore, studies differ largely in perspectives used, disparities in calculation methods of costs and/or charges, included cost items, different inclusion and exclusion criteria and baseline characteristics. 11 The results of this systematic literature review provide a foundation for the development of adequate recommendations to increase uniformity in economic evaluations in spine surgery. Despite the availability of general and national guidelines for the conduct and reporting of economic evaluations, differing levels of adherence result in a wide variety of findings.…”

“…10 11 The results of this broad systematic review show that the importance of economic evaluations is increasingly recognised, as reflected by the increase in the number of cost-effectiveness studies in the last decade. 11 The moderate quality and, more importantly,…”