Cost-effectiveness Analysis of Carbon Fiber (CFR-PEEK) versus Titanium Instrumentation in Spinal Oncology

Introduction: Carbon fiber-reinforced polyetheretherketone (CFR-PEEK) instrumentation presents a recent innovation in materials and implant technology used in spinal oncology. The advantages of CFR-PEEK instrumentation include reductions in postoperative imaging artifacts, thereby improving radiation planning, follow-up imaging quality, and earlier detection of recurrences. The objective of this study is present a cost-effectiveness analysis of CFR-PEEK versus titanium instrumentation technology in patients undergoing surgical decompression and stabilization for a primary or metastatic spinal tumor.

Methods: We performed a decision modeling-based economic evaluation to assess cost-effectiveness. We evaluated costs ($, third-party payer) and effectiveness (quality-adjusted life years [QALYs]) of Titanium-Only versus ‘Hybrid’ CFR-PEEK+Titanium strategies. Estimates for branch probabilities, costs, and QALYs were derived from a retrospective review of our institutional experience. Incremental cost-effectiveness ratios (ICER, $/QALY) were calculated to compare the competing strategies, and a willingness to pay (WTP) threshold was set at $150,000/QALY. One-way, 2-way, and probabilistic sensitivity analyses with 100,000 iterations were performed to account for effects of uncertainty in model inputs.

Results: We included 61 patients (48 Titanium-Only, 13 Hybrid CFR-PEEK) who underwent stabilization at 244 levels. Mean construct length was 4.1 ±1.2 levels in Titanium-Only and 3.4 ±0.9 levels in Hybrid CFR-PEEK. The mean cost of instrumentation per case of Titanium-Only was $8,978 ±2,848 versus Hybrid CFR-PEEK was $20,574 ±5,282. Our base case model demonstrated cost-effectiveness of CFR-PEEK over Titanium at the WTP threshold, with an ICER of $113,211/QALY. One-way sensitivity analysis revealed a Hybrid CFR-PEEK instrumentation cost threshold of $24,602, above which CFR-PEEK is no longer the cost-effective strategy. Probabilistic sensitivity analysis showed Hybrid CFR-PEEK cost-effectiveness in 66% of iterations at the WTP threshold of $150,000/QALY.

Conclusion : Our decision modeling analysis revealed cost-effectiveness of a Hybrid strategy that incorporates CFR-PEEK instrumentation only at the index level of surgery and immediately adjacent spinal level(s). CFR-PEEK implants are a reasonable adjunct to titanium-based screw instrumentation in spinal oncology.