Wednesday, September 26, 2018 7:35 AM–9:00 AM ePosters: P73. Economic study: a cost-effectiveness study of an intraoperative compared with a preoperative image-guided system in spine surgery fixation. Analysis of 10years of experience

Abstract

BACKGROUND CONTEXT Spinal navigation and image-guided system (IGS) are, up to now, well establish technologies, and thanks to their excellent results their spread is growing. In the latest years many publications and meta-analyses demonstrate their accuracy and safety, and even more center adopted IGS in daily activity. However, the acquisition and maintenance costs of these systems are high, and not all the hospital and clinics can effort its purchase. In an era when health expenditure is rising exponentially, cost-effectiveness analyses are mandatory to responsibly manage the scarce health care resources and to define if this technology is economically sustainable and which criteria must be respect to justify its acquisition. PURPOSE The purpose of the present study was to perform a detailed cost-effectiveness analysis to determine the value of a navigation system coupled with intra-operative 3D imaging in adult spinal surgery analyzed thought a micro costing approach in a period of 10years. STUDY DESIGN/SETTING Retrospective cost-effectiveness study. PATIENT SAMPLE Patients operated on our surgical department between 2003 and 2013. METHODS A retrospective cost-effectiveness study was conducted to analyze the overall costs of a population of patients admitted to our Neurosurgical department for spine fixation surgery. In the present study the authors have analyzed the entire population of patients treated for spinal instrumentation with the aid of an IGS system from January 2003 to March 2013. The cost-effectiveness study compared two different type of spinal navigation: system based on a preoperative CT scan (from January 2003 to April 2009 – group I) and the intraoperative CT like scan system (from April 2009 to March 2013 – group II). The economic evaluation is conducted from a hospital perspective. Costs of the two procedures are measured and valued using a microcosting approach. All costs incurred by the hospital are collected from the hospital's accounting service. The evaluation took into consideration all of the phases, from preadmission testing to discharge. Cost of the complications are considered and analyzed as well. RESULTS The study includes 499 patients with a total of 2,542 screws inserted with IGS. Baseline data were similar for the two groups, as were hospitalization and complications. The full cost of the two procedures was analysed: mean cost with intraoperative CT scan system procedure was 6.545 € (±525.9) and 6.853 (±564.3) with preoperative image-guided system. The screws' accuracy were respectively 98.5% and 96.1%. Higher costs were identified for human resources, disposable and implanted materials (more than 1.000 €); in particular, cost of human source were higher for the use of preoperative scan. The higher total cost of the procedure with preoperative scan is related for the major part to the cost of CT scan (preoperative for navigation and postoperative for control). CONCLUSIONS The results of our study show a cost difference that is not statistically significant between the two procedures. However, the use of the intraoperative CT scan system suggests an economic advantage in a long-term point of view. It consent to reduce surgical time and complications bringing to a better clinical result; consent an economics saving in term of human resource and number and type of radiological imaging. A break-even point is estimated after almost 150 procedures. Moreover, nowadays this system is used for more than only screws insertion reducing the financial impact of this technology on the hospital.