Shortfalls in published neurosurgical literature

Area of Science:

• Neurosurgery
• Health Economics
• Clinical Evidence Synthesis

Background:

• Neurosurgical expenditure has risen unevenly since the early 1990s.
• Directing neurosurgical practice requires robust clinical evidence.
• The current literature base may not adequately inform cost-effective decision-making.

Purpose of the Study:

• To explore the neurosurgical literature for the quality of clinical evidence, specifically focusing on cost appraisal.
• To identify gaps in cost-effectiveness analysis within major neurosurgical procedures.
• To propose recommendations for improving the evidence base for neurosurgical interventions.

Main Methods:

• Searched PubMed for English-language neurosurgery literature from 1996 onwards.
• Focused on four major neurosurgical procedures: brain lesion excision, aneurysm clipping/coiling, discectomy, and spine fusion.
• Utilized the keyword "cost" to identify relevant studies and analyzed the level of clinical evidence and cost appraisal.

Main Results:

• A small and static proportion of neurosurgical literature was indexed as level I clinical evidence (randomized controlled trials).
• There was a notable lack of cost appraisal in the outcome analysis of neurosurgical interventions.
• Evidence quality and cost-effectiveness data appear insufficient to guide practice optimally.

Conclusions:

• Enhancing the quality of clinical research in neurosurgery is crucial for national healthcare.
• Increased funding for level I studies incorporating cost analysis is recommended.
• Peer-reviewed journals should require cost-benefit analyses to promote rigorous research and improve healthcare practice.