Cost–utility of minimally invasive versus open transforaminal lumbar interbody fusion: systematic review and economic evaluation

Kevin Phan*, Jarred A. Hogan, Ralph J. Mobbs

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

26 Citations (Scopus)

Abstract

Purpose: To assess the cost–utility and perioperative costs of minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) versus open-TLIF for degenerative lumbar pathologies. Methods: Relevant articles were identified from six electronic databases. Predefined end points were extracted and meta-analysis conducted from the identified studies. Results: For each study, the direct hospital cost for MI-TLIF was found to be less than that of open-TLIF. When these outcomes were pooled, direct hospital costs were found to be significantly lower in the MI-TLIF group [weighted mean difference (WMD), −$2820; I2 = 61 %; P < 0.00001]. MI-TLIF was also associated with shorter hospitalization (WMD, 0.99; 95 % CI −1.81, −0.17; I2 = 96 %; P = 0.02), trend toward reduced complications (relative risk 0.53; 95 % CI 0.23, 1.06; I2 = 0 %; P = 0.07), and reduced blood loss (WMD, −246.40 mL; I2 = 98 %; P = 0.003), but was not associated with a significant difference in operation time (WMD, −67.05; 95 % CI −169.44, 35.35; I2 = 100 %; P = 0.20). Conclusions: From the limited evidence, the available data suggest a trend of significantly reduced perioperative costs, length of stay, and blood loss for minimally invasive compared with open surgical approaches for TLIF. MI-TLIF may represent an opportunity for optimal utilization and allocation of health-care resources from both a hospital and societal perspective.

Original languageEnglish
Pages (from-to)2503-2513
Number of pages11
JournalEuropean Spine Journal
Volume24
Issue number11
DOIs
Publication statusPublished - 21 Jul 2015
Externally publishedYes

Keywords

  • Cost
  • Cost-effectiveness
  • Cost–utility
  • Minimally invasive
  • Transforaminal lumbar interbody fusion

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