Cost-utility analysis in spine care: a systematic review

Area of Science:

• Health Economics
• Spine Surgery
• Clinical Research

Background:

• Cost-utility analyses (CUAs) are crucial for healthcare decision-making.
• A significant gap exists in the number of CUAs conducted for spinal care interventions.

Purpose of the Study:

• To systematically review all published cost-utility studies on spinal care from 1976 to 2010.
• To identify trends, methodologies, and cost-effectiveness findings in spinal care research.

Main Methods:

• Systematic review of 33 cost-utility studies identified from the CEA registry and NHS EED.
• Keywords included spine, spinal, neck, back, cervical, lumbar, thoracic, and scoliosis.
• Data extracted on study subject, methodology, funding, perspective, discount rate, and cost-utility ratios.

Main Results:

• Studies varied widely in methodology, focusing on lumbar (n=27), cervical (n=4), and scoliosis (n=1) spine conditions.
• Of 60 reported cost-utility ratios, 31.6% were cost-saving, 45% were <$100,000/QALY, and 23.3% were >$100,000/QALY.
• Only 12% of studies met all key criteria for cost-effectiveness research.

Conclusions:

• Despite 33 CUAs published over 30 years, further research is needed to fully establish the value of many spinal care aspects.
• Certain spinal care interventions demonstrate cost-effectiveness.
• Future CUAs should incorporate a societal cost perspective and consider the durability of clinical benefits for study time horizons.