• Diogo Garcia, Oluwaseun O Akinduro, Gaetano De Biase, Bernardo Sousa-Pinto, Daniel J Jerreld, Ruchita Dholakia, Bijan Borah, Eric Nottmeier, H Gordon Deen, W Christopher Fox, Mohamad Bydon, Selby Chen, Alfredo Quinones-Hinojosa, and Kingsley Abode-Iyamah.
• Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA.
• Neurosurgery. 2022 Feb 1; 90 (2): 192-198.

BackgroundManagement of degenerative disease of the spine has evolved to favor minimally invasive techniques, including nonrobotic-assisted and robotic-assisted minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). Value-based spending is being increasingly implemented to control rising costs in the US healthcare system. With an aging population, it is fundamental to understand which procedure(s) may be most cost-effective.ObjectiveTo compare robotic and nonrobotic MIS-TLIF through a cost-utility analysis.MethodsWe considered direct medical costs related to surgical intervention and to the hospital stay, as well as 1-yr utilities. We estimated costs by assessing all cases involving adults undergoing robotic surgery at a single institution and an equal number of patients undergoing nonrobotic surgery, matched by demographic and clinical characteristics. We adopted a willingness to pay of $50 000/quality-adjusted life year (QALY). Uncertainty was addressed by deterministic and probabilistic sensitivity analyses.ResultsCosts were estimated based on a total of 76 patients, including 38 undergoing robot-assisted and 38 matched patients undergoing nonrobot MIS-TLIF. Using point estimates, robotic surgery was projected to cost $21 546.80 and to be associated with 0.68 QALY, and nonrobotic surgery was projected to cost $22 398.98 and to be associated with 0.67 QALY. Robotic surgery was found to be more cost-effective strategy, with cost-effectiveness being sensitive operating room/materials and room costs. Probabilistic sensitivity analysis identified robotic surgery as cost-effective in 63% of simulations.ConclusionOur results suggest that at a willingness to pay of $50 000/QALY, robotic-assisted MIS-TLIF was cost-effective in 63% of simulations. Cost-effectiveness depends on operating room and room (admission) costs, with potentially different results under distinct neurosurgical practices.Copyright © Congress of Neurological Surgeons 2021. All rights reserved.

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