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

Systematic review.

The purpose of this study was to assess the cost-effectiveness of surgery for spinal metastasis therapy.

The optimal treatment for many cases of spinal metastasis (SM) is surgery followed by adjuvant radiotherapy (RT). However, the cost-effectiveness of combined therapy (CT; surgery and RT) is unclear due to the short median survival time among SM patients and the higher costs of combined therapy compared with RT alone.

We performed a systematic literature search from inception to January 21, 2024. We included studies that reported on the cost-effectiveness of surgical intervention for SM and assessed their quality using the Quality of Health Economic Studies instrument.

We identified 5024 studies of which eight met our inclusion. All included studies were of fair to high quality. Of the seven studies that compared CT to definitive RT, six concluded that CT was cost-effective. Of note, one of the studies concluding that CT was cost-effective, only found CT to be cost-effective when considering patients with a three-month survival probability above 50%. An additional study compared their calculated Incremental Cost-Effectiveness Ratio (ICER) value to the standard Willingness to Pay (WTP) threshold in Thailand and concluded that CT was not cost-effective in Thailand. After comparing their reported ICER value to a commonly used WTP in the United States, we found CT to be cost-effective.

We found CT consisting of surgery and RT to be cost effective in six out of seven (85.7%) studies. Cost effectiveness might be even more pronounced in certain patient subgroups, such as patients with a high predicted survival. However, most studies did not report therapy details, a factor which could greatly influence cost-effectiveness.