Cost-effectiveness of Surgery for Spinal Metastasis

Study Design. Systematic review. Objective. The purpose of this study was to assess the cost-effectiveness of surgery for spinal metastasis therapy. Summary of Background Data. 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. Methods. 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. Results. 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. Conclusions. 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.