• Isobel Turner, Joanne Kennedy, Stephen Morris, Alan Crockard, and David Choi.
• Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, London, United Kingdom. Electronic address: isobel.turner1@nhs.net.
• World Neurosurg. 2018 Jan 1; 109: e389-e397.

BackgroundSurgery for symptomatic spinal metastases is effective at prolonging ambulation and life, but it can appear costly at first glance. We have studied the difference between the cost of surgery and reimbursement received, and the cost-effectiveness of surgery in a U.K. tertiary referral spinal center.MethodsA cost-versus-reimbursement and cost-utility analysis was performed in a prospective cohort of patients admitted for surgical treatment of spinal metastases. Outcome measures were health-related quality of life using the EuroQol EQ-5D-3L, Frankel score, quality-adjusted life years (QALYs), and treatment and reimbursement costs.ResultsOne hundred thirty consecutive patients were prospectively recruited, of whom 92 had information available for cost and reimbursement comparison, and 100 had information to complete cost-utility analysis. Median cost of hospital treatment per patient was £20,752; median reimbursement received was £18,291, with a median shortfall of £1,967. Surgery in addition to radiotherapy over a lifetime horizon was both more effective and less costly than radiotherapy alone, and therefore was found to be cost-effective.ConclusionsOur results demonstrate that reimbursement to hospitals for surgical management of symptomatic spinal metastases in the United Kingdom is broadly in line with costs, and that there was an overall saving as a result of community care costs being mitigated by patients walking for longer, which is within the expected National Health Service threshold. Surgery for metastatic spinal tumors is effective and a good value for the money.Copyright © 2017 Elsevier Inc. All rights reserved.

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