CFR-PEEK is an alternative to Titanium-based instrumentation offering reduced artifact and comparable biomechanical properties. However, its clinical outcomes, complication profile, and cost-effectiveness remain underexplored. In this study, we aim to: (1) Evaluate clinical results of patients who underwent surgical decompression and stabilization using CFR-PEEK instrumentation for primary or metastatic spinal tumors; (2) Perform a systematic review summarizing the published literature on CFR-PEEK in spinal oncology, and (3) Present a model for cost-effectiveness analysis of ‘Hybrid’ CFR-PEEK versus titanium instrumentation strategies. We conducted: 1) A retrospective review of patients who underwent surgery for primary/metastatic spinal tumors using ‘Hybrid’ CFR-PEEK/Titanium. We assessed demographics, perioperative characteristics, hardware complications, local recurrence, and mortality. 2) Systematic review of CFR-PEEK instrumentation in spinal oncology. 3) Decision modeling-based economic evaluation comparing cost () and effectiveness (QALYs) of ‘Hybrid’ versus Titanium-only constructs. ICERs were calculated using a 150, 000/QALY WTP threshold. Twenty-four patients (52. 2% male) underwent surgery with ‘Hybrid/CFR-PEEK’ instrumentation at a total of 81 levels (mean 6. 75 ± 1. 8 screws/case). Patients underwent postoperative radiation in 16/24 (66. 7%), of whom 10/16 (62. 5%) received SBRT. Eleven patients had 15 complications with 1 hardware failure, 2 infections, and 4 reoperations. Mean follow-up was 7. 8 ± 6. 1 months. Local recurrence or progression occurred in 5/24 (20. 8%) and mortality in 10/24 (41. 7%) patients. In the systematic review, 28 articles met criteria (1, 682 patients, Titanium 153 versus Carbon Fiber 1, 529). Approximately 5, 305 instrumented levels were analyzed, including 7, 961 CFR-PEEK screws. Follow-up duration was ~ 14. 11 months, with a total 294 complications and mortality rate of 18. 2%. In our economic analysis, the mean cost of screw instrumentation per patient was 10, 248 in the ‘Titanium’ cohort and between 8, 805 - 22, 012 in the ‘Hybrid/CFR-PEEK’ cohort. ICER for ‘Hybrid’/CFR-PEEK’ was 124, 587/QALY at a cost of 3, 420 per CFR-PEEK screw (3x Titanium) and 162, 207/QALY at 3, 990 per CFR-PEEK screw (3. 5x Titanium). Reductions in CFR-PEEK screw costs demonstrated further cost-effectiveness at increased CFR-PEEK screw proportions within the construct. Probabilistic Sensitivity Analysis (PSA) with Monte Carlo Simulation trials confirmed our findings. CFR-PEEK instrumentation is safe, feasible, and potentially cost-effective in spinal oncology. Hybrid constructs offer a practical solution to balance clinical utility with cost.
Davidar et al. (Fri,) studied this question.
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