The impact of economic evaluation on quality management in spine surgery

Abstract

Health care expenditures are substantially increasing within the last two decades prompting the imperative need for economic evaluations in health care. Historically, economic evaluations in health care have been carried out by four approaches: (1) the human-capital approach (HCA), (2) cost-effectiveness analysis (CEA), (3) cost-utility analysis (CUA) and (4) cost-benefit analysis (CBA). While the HCA cannot be recommended because of methodological shortcomings, CEA and CUA have been used frequently in healthcare. In CEA, costs are measured in monetary terms and health effects are measured in a non-monetary unit, e.g. number of successfully treated patients. In an attempt to develop an effectiveness measure that incorporates effects on both quantity and quality of life, so-called Quality Adjusted Life Years (QUALYs) were introduced. Contingent valuation surveys are used in cost-benefit analyses (CBA) to elicit the consumer's monetary valuations for program benefits by applying the willingness-to-pay approach. A distinguished feature of CBA is that costs and benefits are expressed in the same units of value, i.e. money. Only recently, economic evaluations have started to explore various spinal interventions particularly the very expensive fusion operations. While most of the studies used CEA or CUA approaches, CBAs are still rare. Most studies fail to show that sophisticated spinal interventions are more cost-effective than conventional treatments. In spite of the lack of therapeutic or cost-effectiveness for most spinal surgeries, there is rapidly growing spinal implant market demonstrating market imperfection and information asymmetry. A change can only be anticipated when physicians start to focus on the improvement of health care quality as documented by outcome research and economic evaluations of cost-effectiveness and net benefits.

Research productivity in neurosurgery: trends in globalization, scientific focus, and funding

“…This is not surprising, given the recent explosion in number of spine procedures being performed and the emerging markets for spinal implants. 4,35 Hydrocephalus, which continues to be a major problem (particularly in the field of pediatric neurosurgery), has also seen growth but maintains overall small numbers of publications. While functional and vascular neurosurgery have only experienced modest growth overall, expansion of publications in the subfields of deep brain stimulation and endovascular techniques demonstrate innovation and high productivity, respectively, with regard to novel approaches and techniques.…”

Economics of image guidance and navigation in spine surgery

“…Accurate placement of instrumentation is critical to avoid iatrogenic morbidity. [ 20 23 25 ] Surgical intervention for spinal pathologies has grown tremendously over the recent years.,[ 4 18 30 ] and has been accompanied by an increase in the incidence of revision spine surgery and arthrodesis. [ 18 ] The current study's aim is to look at the currently published data on the costs and efficacy of spinal navigation.…”

Patient Comorbidities and Complications After Spinal Surgery

“…7 Soegaard et al 8 investigated patient characteristics that infl uenced the cost-effectiveness of lumbar fusion at 2 years. Smoking and a diagnosis of previous spinal surgery were both signifi cantly associated with poorer clinical outcome, increased costs, and a reduction in net benefi t. Another recent economic analysis found that advanced age, diabetes, and obesity were associated with higher hospital costs for patients who underwent spinal surgery.…”