Cost-effective studies in spine surgeries: a narrative review.
BACKGROUND
Although the pathologic processes that affect the spine remain largely unchanged, our techniques to correct them continue to evolve with the development of novel medical and surgical interventions. Although the primary purpose of new technologies is to improve patients' quality of life, the economic impact of such therapies must be considered.


OBJECTIVE
To review the available peer-reviewed literature on spine surgery that addresses the cost-effectiveness of various treatments and technologies.


METHODS
A narrative literature review.


METHODS
Articles published between January 1, 2000 and December 31, 2012 were selected from two Pubmed searches using keywords cost-effectiveness AND spine (216 articles) and cost analysis AND spine (358 articles). Relevant articles on cost analyses and cost-effectiveness were selected by the authors and reviewed.


RESULTS
Cervical and lumbar surgeries (anterior cervical discectomy and fusion, standard open lumbar discectomy, and standard posterior lumbar laminectomy) are reasonably cost effective at 2 years after the procedure (<100,000 US dollars per quality-adjusted life years gained) and become more cost effective with time because of sustained clinical improvements with relatively low additional incurred costs. The usage of transfusion avoidance technology is not cost effective because of the low risk of complications associated with allogenic transfusions. Although intraoperative neuromonitoring and imaging modalities are both cost saving and cost-effective, their cost-effectiveness is largely dependent on the baseline rate of neurologic complications and implant misplacement, respectively. More rigorous studies are needed to evaluate the cost-effectiveness of recombinant bone morphogenetic protein.


CONCLUSIONS
An ideal new technology should be able to achieve maximal improvement in patient health at a cost that society is willing to pay. The cost-effectiveness of technologies and treatments in spine care is dependent on their durability and the rate and severity of the baseline clinical problem that the treatment was designed to address.
Department of Orthopaedic Surgery, Mount Sinai Medical Center, 5 E. 98 St, 9th Floor, Box 1188, New York, NY 10029, USA.
Young
Y
Lu
Department of Orthopaedic Surgery, Mount Sinai Medical Center, 5 E. 98 St, 9th Floor, Box 1188, New York, NY 10029, USA. Electronic address: sheerazqureshi@mountsinai.org.
Sheeraz A
SA
Qureshi
D001803:Blood Transfusion; D019485:Bone Morphogenetic Proteins / Q000191:economics; D003362:Cost-Benefit Analysis; D017586:Diskectomy / Q000191:economics*; D006801:Humans; D007796:Laminectomy / Q000191:economics*; D008159:Lumbar Vertebrae / Q000601:surgery*; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D013123:Spinal Fusion / Q000191:economics*; D013904:Thoracic Vertebrae / Q000601:surgery*; D016896:Treatment Outcome
D019485:Bone Morphogenetic Proteins
Cost-effectiveness; Costs; Economics; Narrative review; Spine surgery; Treatments and technologies