Comparative effectiveness research in spine surgery

2012 ◽  
Vol 33 (1) ◽  
pp. E2 ◽  
Author(s):  
Kalil G. Abdullah ◽  
Edward C. Benzel ◽  
Thomas E. Mroz
Keyword(s):  
Cost Effectiveness ◽  
Spine Surgery ◽  
Comparative Effectiveness Research ◽  
Spinal Surgery ◽  
Comparative Effectiveness ◽  
Effectiveness Research ◽  
Effectiveness Studies

Comparative effectiveness research (CER) has impending significance for the field of spine surgery. This article outlines the rationale for comparative effectiveness research and reviews recommended priorities of spinal surgery emphasis. It also examines recent key studies of CER in the spine surgery literature and associated cost-effectiveness studies. It concludes with a discussion of the direction of CER in the spine surgery community.

scholarly journals Variations in cost calculations in spine surgery cost-effectiveness research

2014 ◽  
Vol 36 (6) ◽  
pp. E1 ◽  
Author(s):  
Matthew D. Alvin ◽  
Jacob A. Miller ◽  
Daniel Lubelski ◽  
Benjamin P. Rosenbaum ◽  
Kalil G. Abdullah ◽  
...  
Keyword(s):  
United Kingdom ◽  
Cost Effectiveness ◽  
Spine Surgery ◽  
Indirect Costs ◽  
Cost Calculation ◽  
Effectiveness Research ◽  
Reimbursement System ◽  
The United Kingdom ◽  
The Cost ◽  
Effectiveness Studies

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.

Comparative effectiveness research in spine surgery

2013 ◽  
Vol 2 (1) ◽  
pp. 45-51 ◽  
Author(s):  
Wendell B Lake ◽  
Nathaniel P Brooks ◽  
Daniel K Resnick
Keyword(s):  
Spine Surgery ◽  
Comparative Effectiveness Research ◽  
Comparative Effectiveness ◽  
Effectiveness Research

scholarly journals The Pragmatist's Guide to Comparative Effectiveness Research

2011 ◽  
Vol 25 (2) ◽  
pp. 27-46 ◽  
Author(s):  
Amitabh Chandra ◽  
Anupam B Jena ◽  
Jonathan S Skinner
Keyword(s):  
Health Care ◽  
Cost Effectiveness ◽  
Comparative Effectiveness Research ◽  
Comparative Effectiveness ◽  
Care Delivery ◽  
Proton Beam Therapy ◽  
Cost Effectiveness Analysis ◽  
New Drugs ◽  
Effectiveness Research ◽  
Effectiveness Analysis

Following an acrimonious health care reform debate involving charges of “death panels,” in 2010, Congress explicitly forbade the use of cost-effectiveness analysis in government programs of the Patient Protection and Affordable Care Act. In this context, comparative effectiveness research emerged as an alternative strategy to understand better what works in health care. Put simply, comparative effectiveness research compares the efficacy of two or more diagnostic tests, treatments, or health care delivery methods without any explicit consideration of costs. To economists, the omission of costs from an assessment might seem nonsensical, but we argue that comparative effectiveness research still holds promise. First, it sidesteps one problem facing cost-effectiveness analysis—the widespread political resistance to the idea of using prices in health care. Second, there is little or no evidence on comparative effectiveness for a vast array of treatments: for example, we don't know whether proton-beam therapy, a very expensive treatment for prostate cancer (which requires building a cyclotron and a facility the size of a football field) offers any advantage over conventional approaches. Most drug studies compare new drugs to placebos, rather than “head-to-head” with other drugs on the market, leaving a vacuum as to which drug works best. Finally, the comparative effectiveness research can prove a useful first step even in the absence of cost information if it provides key estimates of treatment effects. After all, such effects are typically expensive to determine and require years or even decades of data. Costs are much easier to measure, and can be appended at a later date as financial Armageddon draws closer.

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