Robotic-Assisted vs Nonrobotic-Assisted Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Cost-Utility Analysis

• Type: Article in International Scientific Journal
• Date: 2022

Authors

Garcia, D (Author) Other; Akinduro, OO (Author) Other; De Biase, G (Author) Other; Sousa Pinto, B (Author) FMUP; Jerreld, DJ (Author) Other; Dholakia, R (Author) Other; Borah, B (Author) Other; Nottmeier, E (Author) Other; Deen, HG (Author) Other; Fox, WC (Author) Other; Bydon, M (Author) Other; Chen, SLY (Author) Other; Quinones Hinojosa, A (Author) Other; Abode Iyamah, K (Author) Other

Journal

The Journal is awaiting validation by the Administrative Services.

Title: NEUROSURGERY

Vol. 90

Pages: 192-198

ISSN: 0148-396X

Indexing

ISI Web of Knowledge - 37 Citations

Scopus - 36 Citations

Other information

Authenticus ID: P-00W-1HG

DOI: 10.1227/neu.0000000000001779

Abstract (EN): BACKGROUND:Management of degenerative disease of the spine has evolved to favor minimally invasive techniques, including nonrobotic-assisted and robotic-assisted minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). Value-based spending is being increasingly implemented to control rising costs in the US healthcare system. With an aging population, it is fundamental to understand which procedure(s) may be most cost-effective.OBJECTIVE:To compare robotic and nonrobotic MIS-TLIF through a cost-utility analysis.METHODS:We considered direct medical costs related to surgical intervention and to the hospital stay, as well as 1-yr utilities. We estimated costs by assessing all cases involving adults undergoing robotic surgery at a single institution and an equal number of patients undergoing nonrobotic surgery, matched by demographic and clinical characteristics. We adopted a willingness to pay of $50 000/quality-adjusted life year (QALY). Uncertainty was addressed by deterministic and probabilistic sensitivity analyses.RESULTS:Costs were estimated based on a total of 76 patients, including 38 undergoing robot-assisted and 38 matched patients undergoing nonrobot MIS-TLIF. Using point estimates, robotic surgery was projected to cost $21 546.80 and to be associated with 0.68 QALY, and nonrobotic surgery was projected to cost $22 398.98 and to be associated with 0.67 QALY. Robotic surgery was found to be more cost-effective strategy, with cost-effectiveness being sensitive operating room/materials and room costs. Probabilistic sensitivity analysis identified robotic surgery as cost-effective in 63% of simulations.CONCLUSION:Our results suggest that at a willingness to pay of $50 000/QALY, robotic-assisted MIS-TLIF was cost-effective in 63% of simulations. Cost-effectiveness depends on operating room and room (admission) costs, with potentially different results under distinct neurosurgical practices.

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 7