Cost-effectiveness of Surgery for Spinal Metastasis: A Systematic Review.

Abstract

Systematic review. The purpose of this study was to assess the cost-effectiveness of surgery for spinal metastasis therapy. The optimal treatment for many cases of spinal metastasis (SM) is surgery followed by adjuvant radiotherapy (RT). However, the cost-effectiveness of combined therapy (CT; surgery & RT) is unclear due to the short median survival time among SM patients and the higher costs of combined therapy compared to RT alone. We performed a systematic literature search from inception to 01/21/2024. We included studies that reported on the cost-effectiveness of surgical intervention for SM and assessed their quality using Quality of Health Economic Studies instrument. We identified 5,024 studies of which 8 met our inclusion. All included studies were of fair to high quality. Of 7 studies that compared CT to definitive RT, six concluded that CT was cost-effective. Of note, one of the studies concluding that CT was cost-effective, only found CT to be cost effectiveness when considering patients with a 3-month survival probability above 50%. An additional study compared their calculated Incremental Cost Effectiveness Ratio (ICER) value to the standard Willingness to Pay (WTP) threshold in Thailand and concluded that CT was not cost-effective in Thailand. After comparing their reported ICER value to a commonly used WTP in the United States, we found CT to be cost-effective. We found CT consisting of surgery and RT to be cost effective in 6 out of 7 (85.7%) studies. Cost effectiveness might be even more pronounced in certain patient subgroups, such as patients with a high predicted survival. However, most studies did not report therapy details - a factor which could greatly influence cost-effectiveness.