Introduction: The introduction of Exoscopes in spine surgery have provided various benefits. However, the economic benefit of Exoscopes compared to its potential utility has yet to be ascertained. In this abstract, we construct an economic model based on an institutional cohort to determine the cost-benefit of Exoscope use in single/multilevel laminectomies.
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 Exoscope versus Microscope 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 the effects of uncertainty in model inputs.
Results: A total of 55 patients underwent laminectomies (29 Microscope, 26 Exoscope) with mean decompression levels of 2.83±0.89 with Microscopes versus 2.54±0.95 levels with the Exoscope. Mean cost of surgery per level adjusted for inflation with Exoscope was $3338±1254 versus $2499±634 with the Microscope. Our base case model demonstrated cost-effectiveness of Exoscope over Microscope at the WTP threshold, with an ICER of $146,779/QALY. Probabilistic sensitivity analysis showed Exoscope cost-effectiveness in 52% of iterations at the WTP threshold of $150,000/QALY.
Conclusion : With increasing use of Exoscopes in spine surgery, a progressive decrease in mean operative time per level can be attained once the learning curve threshold is reached. Providing ergonomic benefits and potentially favorable post-operative outcomes, exoscope yields economic benefits in laminectomy surgery.
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