Variations in cost calculations in spine surgery cost-effectiveness research

被引:64
作者
Alvin, Matthew D. [1 ,2 ]
Miller, Jacob A. [1 ,3 ]
Lubelski, Daniel [1 ,3 ]
Rosenbaum, Benjamin P. [1 ]
Abdullah, Kalil G. [4 ]
Whitmore, Robert G. [6 ]
Benzel, Edward C. [1 ,3 ,5 ]
Mroz, Thomas E. [1 ,3 ,5 ]
机构
[1] Cleveland Clin, Ctr Spine Hlth, Cleveland, OH 44195 USA
[2] Case Western Reserve Univ, Sch Med, Cleveland, OH USA
[3] Cleveland Clin, Lerner Coll Med, Cleveland, OH 44195 USA
[4] Hosp Univ Penn, Dept Neurosurg, Philadelphia, PA 19104 USA
[5] Cleveland Clin, Dept Neurol Surg, Cleveland, OH 44195 USA
[6] Lahey Hosp & Hlth Syst, Dept Neurol Surg, Burlington, MA USA
关键词
cost-effectiveness analysis; Medicare reimbursement; cost utility; cost-to-charge ratio; health care policy; direct cost; ANTERIOR CERVICAL DISKECTOMY; RANDOMIZED CONTROLLED-TRIAL; LUMBAR DISC HERNIATION; LOW-BACK-PAIN; INTERVENTION CLINICAL ARTICLE; UTILITY ANALYSIS ALONGSIDE; DEGENERATIVE-SPONDYLOLISTHESIS; SURGICAL INTERVENTION; MULTILEVEL HEMILAMINECTOMY; SPONDYLOTIC MYELOPATHY;
D O I
10.3171/2014.3.FOCUS1447
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Object. Cost-effectiveness research in spine surgery has been a prominent focus over the last decade. However, there has yet to be a standardized method developed for calculation of costs in such studies. This lack of a standardized costing methodology may lead to conflicting conclusions on the cost-effectiveness of an intervention for a specific diagnosis. The primary objective of this study was to systematically review all cost-effectiveness studies published on spine surgery and compare and contrast various costing methodologies used. Methods. The authors performed a systematic review of the cost-effectiveness literature related to spine surgery. All cost-effectiveness analyses pertaining to spine surgery were identified using the cost-effectiveness analysis registry database of the Tufts Medical Center Institute for Clinical Research and Health Policy, and the MEDLINE database. Each article was reviewed to determine the study subject, methodology, and results. Data were collected from each study, including costs, interventions, cost calculation method, perspective of cost calculation, and definitions of direct and indirect costs if available. Results. Thirty-seven cost-effectiveness studies on spine surgery were included in the present study. Twenty-seven (73%) of the studies involved the lumbar spine and the remaining 10 (27%) involved the cervical spine. Of the 37 studies, 13 (35%) used Medicare reimbursements, 12 (32%) used a case-costing database, 3 (8%) used cost-to- charge ratios (CCRs), 2 (5%) used a combination of Medicare reimbursements and CCRs, 3 (8%) used the United Kingdom National Health Service reimbursement system, 2 (5%) used a Dutch reimbursement system, 1 (3%) used the United Kingdom Department of Health data, and 1 (3%) used the Tricare Military Reimbursement system. Nineteen (51%) studies completed their cost analysis from the societal perspective, 11 (30%) from the hospital perspective, and 7 (19%) from the payer perspective. Of those studies with a societal perspective, 14 (38%) reported actual indirect costs. Conclusions. Changes in cost have a direct impact on the value equation for concluding whether an intervention is cost-effective. It is essential to develop a standardized, accurate means of calculating costs. Comparability and transparency are essential, such that studies can be compared properly and policy makers can be appropriately informed when making decisions for our health care system based on the results of these studies.
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页数:10
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