Cost-effectiveness of biportal endoscopic spine surgery compared with microscopic surgery for lumbar degenerative diseases: a pooled analysis of 2 randomized controlled trials.
Sang-Min Park, Kwang-Sup Song, Ho-Joong Kim et al.
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In 30 seconds
This economic evaluation pooled data from two multicentre, prospective, blinded randomised trials comparing biportal endoscopic spine surgery (BESS) with microscopic spine surgery (MSS) for single-level lumbar disc herniation or spinal stenosis in South Korea. Of 220 randomised patients, 187 with complete 12-month follow-up were analysed. Mean 1-year QALYs were 0.823±0.079 with BESS and 0.801±0.112 with MSS; costs were USD 3,028 and USD 3,080, respectively. At a willingness-to-pay threshold of USD 21,429 per QALY, BESS had a 94.9% probability of being cost-effective, although neither costs nor QALYs differed significantly.
Key findings
- Mean 1-year QALYs were 0.823±0.079 for BESS and 0.801±0.112 for MSS.
- Total costs were USD 3,028 for BESS and USD 3,080 for MSS; confidence intervals for incremental costs and QALYs crossed zero.
- At the USD 21,429 per-QALY willingness-to-pay threshold, the probability that BESS was cost-effective was 94.9%.
Why it matters
The analysis adds economic evidence to randomised comparisons of two surgical approaches for lumbar degenerative disease. Its findings suggest BESS may offer similar measured costs and QALYs to MSS while having a high probability of cost-effectiveness at the specified Korean threshold. The distinction between that probability and a statistically significant advantage is important when interpreting the result.
What to keep in mind
The analysis included only patients with complete 12-month follow-up, and its cost estimates were measured from the healthcare provider's perspective in South Korea. Follow-up was limited to 12 months.