title: Cost-utility analyses in spine care: a qualitative and systematic review.
abstract: METHODS
  Systematic review.
  
  
  OBJECTIVE
  A systematic review was performed to identify US-based cost-utility analyses (CUA) studies in spine care and to critically evaluate the quality of the available literature.
  
  
  BACKGROUND
  There has been a recent trend in the United States toward increased publication of economic analyses in spine care. The cost-effectiveness of spine interventions and the quality of published literature is not well understood.
  
  
  METHODS
  A MEDLINE search was conducted to identify cost analyses in spine care. Articles were excluded on the basis of the following criteria: nonspine care, nonoperative, non-US based, nonclinical, and not CUA. Of the 424 screened articles, 20 met inclusion criteria. Quality of studies was assessed using the Quality of Health Economic Studies instrument.
  
  
  RESULTS
  Evidence for the cost-effectiveness of operative spinal intervention is varied. The majority of available studies report favorable cost-effectiveness ratios, however, a few studies suggest that certain operative interventions are not cost-effective. Average Quality of Health Economic Studies score of all included studies was 75.1 (60-93). The quality of evidence is variable and there are a number of weaknesses in the available literature, most significant of which is that few studies adopt a long-term time horizon or have sufficient follow-up (N = 3/20). High Quality of Health Economic Studies scoring studies were more likely to have sensitivity analysis (P = 0.016), societal cost perspective (P = 0.014), and a funding disclosure (P = 0.03).
  
  
  CONCLUSIONS
  There is a small but rapidly growing body of US-based CUA in spine care. The quality of CUA evidence is variable but there are significant opportunities to strengthen future CUA studies in spine. This study highlights the need for more attention to CUA research and the quality of these studies in spine care.
authors.affiliation: *Hospital for Special Surgery, New York, NY; and †Weill Medical College of Cornell University, New York, NY.
authors.forename: Benedict U
authors.initials: BU
authors.lastname: Nwachukwu
authors.forename: William W
authors.initials: WW
authors.lastname: Schairer
authors.forename: Grant D
authors.initials: GD
authors.lastname: Shifflett
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Kellner
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Sama
mesh_terms: D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D006801:Humans; D019057:Quality-Adjusted Life Years; D012196:Review Literature as Topic; D013122:Spinal Diseases / Q000191:economics* / Q000628:therapy*; D014481:United States