Document Detail

The impact of economic evaluation on quality management in spine surgery.
MedLine Citation:
PMID:  19337760     Owner:  NLM     Status:  MEDLINE    
Health care expenditures are substantially increasing within the last two decades prompting the imperative need for economic evaluations in health care. Historically, economic evaluations in health care have been carried out by four approaches: (1) the human-capital approach (HCA), (2) cost-effectiveness analysis (CEA), (3) cost-utility analysis (CUA) and (4) cost-benefit analysis (CBA). While the HCA cannot be recommended because of methodological shortcomings, CEA and CUA have been used frequently in healthcare. In CEA, costs are measured in monetary terms and health effects are measured in a non-monetary unit, e.g. number of successfully treated patients. In an attempt to develop an effectiveness measure that incorporates effects on both quantity and quality of life, so-called Quality Adjusted Life Years (QUALYs) were introduced. Contingent valuation surveys are used in cost-benefit analyses (CBA) to elicit the consumer's monetary valuations for program benefits by applying the willingness-to-pay approach. A distinguished feature of CBA is that costs and benefits are expressed in the same units of value, i.e. money. Only recently, economic evaluations have started to explore various spinal interventions particularly the very expensive fusion operations. While most of the studies used CEA or CUA approaches, CBAs are still rare. Most studies fail to show that sophisticated spinal interventions are more cost-effective than conventional treatments. In spite of the lack of therapeutic or cost-effectiveness for most spinal surgeries, there is rapidly growing spinal implant market demonstrating market imperfection and information asymmetry. A change can only be anticipated when physicians start to focus on the improvement of health care quality as documented by outcome research and economic evaluations of cost-effectiveness and net benefits.
Norbert Boos
Publication Detail:
Type:  Journal Article; Review     Date:  2009-04-01
Journal Detail:
Title:  European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society     Volume:  18 Suppl 3     ISSN:  1432-0932     ISO Abbreviation:  Eur Spine J     Publication Date:  2009 Aug 
Date Detail:
Created Date:  2009-07-29     Completed Date:  2009-11-13     Revised Date:  2013-06-02    
Medline Journal Info:
Nlm Unique ID:  9301980     Medline TA:  Eur Spine J     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  338-47     Citation Subset:  IM    
Centre for Spinal Surgery, University of Zurich, University Hospital Balgrist, Forchstrasse 340, 8008 Zurich, Switzerland.
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MeSH Terms
Cost Control / methods,  trends
Cost-Benefit Analysis / methods*,  standards,  statistics & numerical data,  trends
Neurosurgical Procedures / economics*,  standards,  statistics & numerical data
Outcome Assessment (Health Care) / economics*,  methods,  standards
Quality Assurance, Health Care / economics*,  methods,  standards
Quality of Life
Spinal Fusion / economics,  instrumentation,  methods

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