Cost-Effectiveness of Surgery for Spinal Metastasis: A Systematic Review

Area of Science:

• Oncology
• Health Economics
• Surgical Oncology

Background:

• Spinal metastasis (SM) management often involves surgery followed by adjuvant radiotherapy (RT).
• The cost-effectiveness of combined therapy (CT; surgery & RT) for SM is debated due to patient survival and treatment costs.
• Optimal treatment strategies require careful economic evaluation.

Purpose of the Study:

• To systematically review and assess the cost-effectiveness of surgical interventions for spinal metastasis.
• To evaluate the economic value of combined therapy (surgery and radiotherapy) versus other treatment modalities.

Main Methods:

• Systematic literature search conducted up to January 21, 2024.
• Inclusion of studies reporting cost-effectiveness of surgical intervention for SM.
• Quality assessment using the Quality of Health Economic Studies (QHES) instrument.

Main Results:

• Eight studies met inclusion criteria, all of fair to high quality.
• Six of seven studies comparing CT to definitive RT found CT to be cost-effective.
• Cost-effectiveness varied based on patient survival probability and regional willingness-to-pay thresholds.

Conclusions:

• Combined therapy (surgery and RT) for spinal metastasis is cost-effective in the majority of evaluated studies (85.7%).
• Cost-effectiveness may be enhanced in patient subgroups with higher predicted survival.
• Lack of detailed therapy reporting in studies limits definitive conclusions on cost-effectiveness.