title: A cost-minimization analysis in minimally invasive spine surgery using a national cost scale method.
abstract: BACKGROUND
  The last decade has seen the emergence of minimally invasive spine surgery. However, there is still no consensus on whether percutaneous osteosynthesis (PO) or open surgery (OS) is more cost-effective in treatment of traumatic fractures and degenerative lesions. The objective of this study is to compare the clinical results and hospitalization costs of OS and PO for degenerative lesions and thoraco-lumbar fractures.
  
  
  METHODS
  This cost-minimization study was performed in patients undergoing OS or PO on a 36-month period. Patient data, surgical and clinical results, as well as cost data were collected and analyzed. The financial costs were calculated based on diagnosis related group reimbursement and the French national cost scale, enabling the evaluation of charges for each hospital stay.
  
  
  RESULTS
  46 patients were included in this cost analysis, 24 patients underwent OS and 22 underwent PO. No significant difference was found between surgical groups in terms of patient's clinical features and outcomes during the patient hospitalization. The use of PO was significantly associated with a decrease in Length Of Stay (LOS). The cost-minimization revealed that PO is associated with decreased hospital charges and shorten LOS for patients, with similar clinical outcomes and medical device cost to OS.
  
  
  CONCLUSIONS
  This medico-economic study has leaded to choose preferentially the use of minimally invasive surgery techniques. This study also illustrates the discrepancy between the national health system reimbursement and real hospital charges. The medico-economic is becoming critical in the current context of sustainable health resource allocation.
authors.affiliation: Pharmacy Department, University Hospital, Nantes, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Maillard
authors.affiliation: Neurotraumatology Department, University Hospital, Nantes, France.
authors.forename: Kevin
authors.initials: K
authors.lastname: Buffenoir-Billet
authors.affiliation: Neurotraumatology Department, University Hospital, Nantes, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Hamel
authors.affiliation: Pharmacy Department, St Louis Hospital, La Rochelle, France.
authors.forename: Benoit
authors.initials: B
authors.lastname: Lefranc
authors.affiliation: Pharmacy Department, University Hospital, Nantes, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Sellal
authors.affiliation: Public Health Department, University Hospital, Nantes, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Surer
authors.affiliation: Neurotraumatology Department, University Hospital, Nantes, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Bord
authors.affiliation: Pharmacy Department, University Hospital, Nantes, France.
authors.forename: Gael
authors.initials: G
authors.lastname: Grimandi
authors.affiliation: Pharmacy Department, University Hospital, Nantes, France. Electronic address: johann.clouet@chu-nantes.fr.
authors.forename: Johann
authors.initials: J
authors.lastname: Clouet
mesh_terms: D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000191:economics* / Q000379:methods; D005602:France; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008159:Lumbar Vertebrae / Q000293:injuries / Q000601:surgery; D019060:Minimally Invasive Surgical Procedures / Q000191:economics*; D009313:National Health Programs; D013122:Spinal Diseases / Q000191:economics / Q000601:surgery*; D016103:Spinal Fractures / Q000191:economics / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000293:injuries / Q000601:surgery; D016896:Treatment Outcome
keywords: Cost minimization analysis; Lumbar degenerative lesions; Mini-invasive surgery; Thoraco-lumbar fractures