[Possibilities for cost reduction of implants in spinal surgery]

To evaluate the possibilities for cost reduction in spinal surgery by analysing implant costs and the efficiency of each type of implant.

The costs of spinal implant methods, as well as Halo-vest for craniocervical, cervical, thoracic, lumbar spine are summarised according to an analysis of price lists from 2001 and 2002. The different methods were additionally evaluated with regard to the scientifically-based treatment efficiency. All prices above 100 euro were rounded up to the closest 50 euro. For the implants, a literature research was performed. The scientific papers were divided into groups according to their level of evidence (I a -IV), and then further subdivided into comparable and non-comparable categories.

Craniocervical: Halo-vest 1,700-2,500 euro, odontoidscrew 100-250 euro, plate 1,300 euro, wire 20-250 euro; plate-wire-, rod-wire- or rod-screw systems 400-1,800 euro, clamps 1,200 euro, Cervical: placeholder 20-500 euro, vertebral body replacement 400-1,300 euro, plate 75-450 euro; rod- or plate-screw systems 900-1,700 euro; Thoracic/lumbar: plate/rod-systems 1,000-2,800 euro, vertebral body replacement 500-1,300 euro, internal fixateur 800-2,500 euro, cages 600-1,500 euro. For none of the implant methods were comparable scientific clinical publications found with a high levels of evidence (I a-I b).

Costs can be reduced through a more thorough investigation and corresponding choice of implant method. The cost-benefit analysis of new spinal implants must be considered more with regard to the evidence-based spinal surgery. In order to sufficiently evaluate the different treatment methods, future multicenter controlled comparable studies and meta-analyses must be undertaken.