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Robotic-Assisted vs Nonrobotic-Assisted Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Cost-Utility

Diogo Garcia¹, Oluwaseun O Akinduro¹, Gaetano De Biase¹

¹Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA.

|January 13, 2022

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This summary is machine-generated.

Robotic-assisted minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is a more cost-effective strategy than nonrobotic MIS-TLIF. This finding holds true at a willingness to pay of $50,000 per quality-adjusted life year (QALY).

Area of Science:

Neurosurgery
Health Economics
Medical Technology Assessment

Background:

Spine surgery increasingly utilizes minimally invasive techniques, including robotic-assisted and nonrobotic approaches for transforaminal lumbar interbody fusion (MIS-TLIF).
Value-based healthcare models are being adopted to manage rising healthcare expenditures in the US.
Understanding the cost-effectiveness of different surgical procedures is crucial, especially with an aging population.

Purpose of the Study:

To conduct a cost-utility analysis comparing robotic-assisted and nonrobotic minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF).

Main Methods:

Direct medical costs and 1-year utilities were assessed for both robotic and nonrobotic MIS-TLIF procedures.
A cohort of adult patients undergoing either robotic or nonrobotic MIS-TLIF at a single institution was analyzed, with matched demographic and clinical characteristics.

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A willingness to pay threshold of $50,000 per quality-adjusted life year (QALY) was applied, and sensitivity analyses were performed to address uncertainty.

Main Results:

The analysis included 76 patients (38 robotic, 38 nonrobotic).
Robotic MIS-TLIF was projected to cost $21,546.80 with 0.68 QALYs, versus $22,398.98 with 0.67 QALYs for nonrobotic MIS-TLIF.
Robotic surgery was identified as the more cost-effective strategy, with probabilistic sensitivity analysis indicating cost-effectiveness in 63% of simulations.

Conclusions:

Robotic-assisted MIS-TLIF demonstrates cost-effectiveness at a willingness to pay of $50,000/QALY in 63% of simulations.
The cost-effectiveness is sensitive to operating room and admission costs, suggesting potential variations across different neurosurgical practices.
These findings support the consideration of robotic assistance for MIS-TLIF within value-based healthcare frameworks.