title: A Cost-Effectiveness Analysis of Minimally Invasive versus Open Surgery Techniques for Lumbar Spinal Fusion in Italy and the United Kingdom.
abstract: OBJECTIVE
  Evaluate the cost-effectiveness of minimally invasive surgery (MIS) compared with open surgery (OS) techniques for one- or two-level lumbar spinal fusion in the treatment of degenerative lumbar spinal conditions in the United Kingdom and Italy.
  
  
  METHODS
  A health economic model was developed on the basis of results from a systematic literature review and meta-analysis to determine the cost-effectiveness of MIS compared with OS for lumbar spinal fusion. The analysis was conducted from a health care payer perspective. Parameters included in the model were surgery, blood loss, duration of hospitalization, postoperative complications, and health-related quality of life (HRQOL). Cost-effectiveness was determined by the incremental cost per quality-adjusted life-year gained.
  
  
  RESULTS
  MIS was the dominant strategy compared with OS (i.e., yielding both cost savings and improved HRQOL). Cost savings were driven mainly by shorter length of hospital stay, reduced blood loss, and fewer complications such as surgical site infection. The total cost saving per procedure was €973 for Italy and €1666 for the United Kingdom, with an improvement of 0.04 quality-adjusted life-year over 2 years in HRQOL. One-way sensitivity analyses and predefined scenario(s) analyses confirmed the robustness of the model.
  
  
  CONCLUSIONS
  MIS is a less expensive and a more effective treatment compared with OS for spinal lumbar fusion in both Italy and the United Kingdom. Lower downstream costs and increased HRQOL in the MIS group compensate for potential higher upfront costs of MIS implants and surgery equipment.
authors.affiliation: OptumInsight, Stockholm, Sweden. Electronic address: simona.vertuani@optum.com.
authors.forename: Simona
authors.initials: S
authors.lastname: Vertuani
authors.affiliation: OptumInsight, Stockholm, Sweden.
authors.forename: Jonas
authors.initials: J
authors.lastname: Nilsson
authors.affiliation: Spine & Biologics Medtronic International Trading SARL, Tolochenaz, Switzerland.
authors.forename: Benny
authors.initials: B
authors.lastname: Borgman
authors.affiliation: Health Economics & Reimbursement, Medtronic Italy, Milan, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Buseghin
authors.affiliation: Medtronic Limited UK, Watford, UK.
authors.forename: Catherine
authors.initials: C
authors.lastname: Leonard
authors.affiliation: Division of Neurosurgery, AO Fatebenefratelli e Oftalmico, Milan, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Assietti
authors.affiliation: Centre for Spinal Studies & Surgery, Nottingham, UK.
authors.forename: Nasir A
authors.initials: NA
authors.lastname: Quraishi
mesh_terms: D016063:Blood Loss, Surgical / Q000517:prevention & control; D057186:Comparative Effectiveness Research; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005060:Europe; D017048:Health Care Costs; D006801:Humans; D007558:Italy; D007902:Length of Stay / Q000191:economics; D008159:Lumbar Vertebrae / Q000601:surgery*; D019060:Minimally Invasive Surgical Procedures / Q000191:economics; D018803:Models, Economic; D018579:Patient Selection; D011183:Postoperative Complications / Q000191:economics / Q000517:prevention & control; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D013123:Spinal Fusion / Q000009:adverse effects / Q000191:economics* / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome
keywords: cost-effectiveness; health economic model; lumbar spinal fusion; minimally invasive surgery