title: Cost-effectiveness of surgery in the management of metastatic epidural spinal cord compression: a systematic review.
abstract: METHODS
  Systematic review.
  
  
  OBJECTIVE
  To perform an evidence-based synthesis of the literature to examine the cost-effectiveness of surgery in the management of metastatic epidural spinal cord compression (MESCC).
  
  
  BACKGROUND
  Between 2.5% and 10% of patients with cancer develop symptomatic MESCC, which leads to significant morbidity, and a reduction in quality and length of life. Although surgery is being increasingly used in the management of MESCC, it is unclear whether this modality is cost-effective, given the relatively limited lifespan of these patients.
  
  
  METHODS
  Numerous databases were searched to identify full economic studies based on key questions established a priori. Only economic studies that evaluated and synthesized the costs and consequences (i.e., cost-minimization, cost-benefit, cost-effectiveness, or cost-utility) were considered for inclusion. Two independent reviewers examined the full text of the articles meeting inclusion criteria to obtain the final cohort of included studies. The Quality of Health Economic Studies instrument was scored by 2 independent reviewers.
  
  
  RESULTS
  The search strategy yielded 38 potentially relevant citations, 2 of which met the inclusion criteria. One was a cost-utility study and the other was a cost-effectiveness study, and both used clinical data from the same randomized controlled trial. Both studies found surgery plus radiotherapy to be not only more expensive but also more effective than radiotherapy alone in the management of patients with MESCC.
  
  
  CONCLUSIONS
  There is evidence from 2 high-quality studies that surgery plus radiotherapy is costlier but clinically more effective than radiotherapy alone for the management of MESCC. Of note, cost-effectiveness data for the role of spinal stabilization in the management of oncological spinal instability are lacking. This is a key knowledge gap that represents an opportunity for future research.
authors: *Division of Neurosurgery and Spinal Program, University of Toronto, Toronto, Ontario, Canada; and †Spectrum Research, Tacoma, WA.
authors: Michael G
authors: MG
authors: Fehlings
authors: Anick
authors: A
authors: Nater
authors: Haley
authors: H
authors: Holmer
mesh_terms: D003362:Cost-Benefit Analysis; D019299:Decompression, Surgical / Q000191:economics*; D015174:Epidural Neoplasms / Q000150:complications / Q000191:economics* / Q000556:secondary / Q000628:therapy*; D017048:Health Care Costs; D006801:Humans; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D018714:Radiotherapy, Adjuvant / Q000191:economics; D013117:Spinal Cord Compression / Q000191:economics* / Q000209:etiology / Q000628:therapy*