title: Perspective of Value-Based Management of Spinal Disorders in Brazil.
abstract: BACKGROUND
  The state of value-based management of spinal disorders and ongoing Brazilian strategies toward its implementation are highlighted in this article.
  
  
  METHODS
  The health care system, economic impact of spine surgery, use of patient-reported outcomes, ongoing studies about health economics, and current strategies toward implementation of quality assessment of spine care in Brazil are reviewed.
  
  
  RESULTS
  During the past 20 years, there has been an increase of 226% in the number and 540% in the total cost of spine surgeries in the public health system. Examples of economic regulatory mechanisms involve the process of health technology assessment and the auditing processes imposed by health insurance companies. Some barriers to implementing clinical registries were identified from a large Latin American survey. Strategies based on education and technical support have been conducted to improve the quality of comparative-effectiveness research in spine care. Only 1 cost-utility study on spine care has been published until now.
  
  
  CONCLUSIONS
  The paradigm of value-based management of spinal disorders is still incipient in Brazil. Some issues from our analysis must be emphasized: (1) Brazil presents many regional disparities and scarce resources for health care; it is crucial for the health system to allocate resources based on the value of interventions; (2) because of the high economic and social burden of developing new technologies for diagnosis and treatment, research in health economics of spine care in Brazil should be prioritized; (3) these efforts would help to provide a more accessible and effective health system for patients with spinal problems.
authors.affiliation: Department of Neurosurgery, Laboratory of Clinical Studies and Basic Models of Spinal Disorders, Universidade de Caxias do Sul, Caxias do Sul, RS, Brazil. Electronic address: alisson.r.teles@gmail.com.
authors.forename: Alisson R
authors.initials: AR
authors.lastname: Teles
authors.affiliation: Department of Orthopedics, Universidade de Caxias do Sul, Caxias do Sul, RS, Brazil.
authors.forename: Orlando
authors.initials: O
authors.lastname: Righesso
authors.affiliation: Department of Economics, Universidade de Caxias do Sul, Caxias do Sul, RS, Brazil.
authors.forename: Maria Carolina R
authors.initials: MC
authors.lastname: Gullo
authors.affiliation: Alan and Jacqueline Stuart Spine Center, Department of Neurosurgery, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA; Tufts University School of Medicine, Boston, Massachusetts, USA.
authors.forename: Zoher
authors.initials: Z
authors.lastname: Ghogawala
authors.affiliation: Department of Neurosurgery, Laboratory of Clinical Studies and Basic Models of Spinal Disorders, Universidade de Caxias do Sul, Caxias do Sul, RS, Brazil.
authors.forename: Asdrubal
authors.initials: A
authors.lastname: Falavigna
mesh_terms: D000328:Adult; D000368:Aged; D001938:Brazil; D057186:Comparative Effectiveness Research; D017281:Cost of Illness; D019468:Disease Management; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D009493:Neurosurgery / Q000191:economics / Q000639:trends; D011785:Quality Assurance, Health Care; D012042:Registries; D040841:Resource Allocation; D013122:Spinal Diseases / Q000191:economics* / Q000601:surgery / Q000628:therapy*; D016896:Treatment Outcome
keywords: Brazil; Cost-effectiveness; Cost-utility; Costs; QALY; Quality of life; Spine; Surgery; Value