title: Variations in cost calculations in spine surgery cost-effectiveness research.
abstract: OBJECTIVE
  Cost-effectiveness research in spine surgery has been a prominent focus over the last decade. However, there has yet to be a standardized method developed for calculation of costs in such studies. This lack of a standardized costing methodology may lead to conflicting conclusions on the cost-effectiveness of an intervention for a specific diagnosis. The primary objective of this study was to systematically review all cost-effectiveness studies published on spine surgery and compare and contrast various costing methodologies used.
  
  
  METHODS
  The authors performed a systematic review of the cost-effectiveness literature related to spine surgery. All cost-effectiveness analyses pertaining to spine surgery were identified using the cost-effectiveness analysis registry database of the Tufts Medical Center Institute for Clinical Research and Health Policy, and the MEDLINE database. Each article was reviewed to determine the study subject, methodology, and results. Data were collected from each study, including costs, interventions, cost calculation method, perspective of cost calculation, and definitions of direct and indirect costs if available.
  
  
  RESULTS
  Thirty-seven cost-effectiveness studies on spine surgery were included in the present study. Twenty-seven (73%) of the studies involved the lumbar spine and the remaining 10 (27%) involved the cervical spine. Of the 37 studies, 13 (35%) used Medicare reimbursements, 12 (32%) used a case-costing database, 3 (8%) used cost-to-charge ratios (CCRs), 2 (5%) used a combination of Medicare reimbursements and CCRs, 3 (8%) used the United Kingdom National Health Service reimbursement system, 2 (5%) used a Dutch reimbursement system, 1 (3%) used the United Kingdom Department of Health data, and 1 (3%) used the Tricare Military Reimbursement system. Nineteen (51%) studies completed their cost analysis from the societal perspective, 11 (30%) from the hospital perspective, and 7 (19%) from the payer perspective. Of those studies with a societal perspective, 14 (38%) reported actual indirect costs.
  
  
  CONCLUSIONS
  Changes in cost have a direct impact on the value equation for concluding whether an intervention is cost-effective. It is essential to develop a standardized, accurate means of calculating costs. Comparability and transparency are essential, such that studies can be compared properly and policy makers can be appropriately informed when making decisions for our health care system based on the results of these studies.
authors.affiliation: Cleveland Clinic Center for Spine Health, Cleveland Clinic, Cleveland;
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Alvin
authors.forename: Jacob A
authors.initials: JA
authors.lastname: Miller
authors.forename: Daniel
authors.initials: D
authors.lastname: Lubelski
authors.forename: Benjamin P
authors.initials: BP
authors.lastname: Rosenbaum
authors.forename: Kalil G
authors.initials: KG
authors.lastname: Abdullah
authors.forename: Robert G
authors.initials: RG
authors.lastname: Whitmore
authors.forename: Edward C
authors.initials: EC
authors.lastname: Benzel
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Mroz
mesh_terms: D003362:Cost-Benefit Analysis / Q000191:economics* / Q000379:methods; D006801:Humans; D013122:Spinal Diseases / Q000191:economics* / Q000601:surgery*; D013123:Spinal Fusion / Q000191:economics* / Q000379:methods
keywords: ACDF = anterior cervical discectomy and fusion; CCR = cost-to-charge ratio; CEA = cost-effectiveness analysis; CER = cost-effectiveness ratio; CUA = cost-utility analysis; ICER = incremental cost-effectiveness ratio; Medicare reimbursement; QALY = quality-adjusted life year; cost utility; cost-effectiveness analysis; cost-to-charge ratio; direct cost; health care policy