Analisi di costo-utilità della stabilizzazione vertebrale mininvasiva versus l’approccio convenzionale in open
Ilaria Barbato, Barbara Esposito, Virginia Cristiano, Massimo Natale
Objective: The Neurosurgery of the CTO hospital performs an average of 12 vertebral stabilization annually. The stabilization techniques include conventional surgery in open (OS) and minimally invasive surgery (MIS). The stabilization is necessary to reduce deformities and instability of the column, in the event of disk degeneration, fractures and to alleviate the pain. The degeneration of the disks may have a negative impact on physical function and quality of life (QoL). The OS procedures require larger incisions and extensive muscle dissection compared with MIS procedures. The objective of this work was to analyze the utility obtained by the two approaches, correlate the utility with costs and conduct a cost-utility study to analyze the variables involved, and guide operators in a conscious choice on the approach to be used.
Methods: Analysis of the costs and QALYs (Quality-Adjusted Life-Years) for patients operated in 2014 and 2015 by MIS and OS was performed. The costs were calculated by adding the cost of surgery (operating room personnel, medical devices, for stabilization tools, transfusions), drug therapy, hospitalization, diagnostic imaging performance. The QALY was calculated to one year of surgery through interviews with medical staff using a questionnaire EuroQol to 5 dimensions that measure the QoL by analyzing mobility, personal care, usual activities, pain and anxiety or depression.
Results: Between 2014 and 2015, 22 patients were operated, including 9 women and 13 men, 6 in MIS and 16 in OC, the average age of the patients was 57 years. The MIS costs were € 11,443.1 vs OC costs of € 12,591.2, which was associated with less use of resources thanks to a shorter post operative hospital stay (4 vs 8 days), and minor blood loss. The QALYs were 0.74 for the MIS vs 0.69 for OS. The MIS approach resulted dominant because was more effective and less expensive.
Conclusions: The analysis confirms that patients treated with MIS approach, less invasive, have better outcomes with fewer side effects such as blood loss, transfusion, postoperative pain and shorter hospitalization. Also the cost is lower, confirming the minimally invasive surgery as dominant. The cost-utility analysis, therefore, increases the knowledge on the economic and clinical consequences of choices, providing support to improve the quality and consistency of decisions.
Key words: spinal fusion, minimally invasive surgery, cost-utility analysis