11 socioeconomics in spine surgerypainful degenerative lumbar spine (PDLS) surgerysocioeconomicsSocioeconomics in Spine Surgery

The huge increase in national healthcare expense has resulted in the interjection of economic “stakeholders” into the medical decision processes. Cost-effectiveness (CE) analysis, utilizing comparative effectiveness research (CER), has established the cost/QALY value metric, based on utility health-related quality of life (HRQL) outcome measures. There are unavoidable limitations in the establishment of this metric.These administrative/political cost-control initiatives have increasingly relied on evidence-based medicine (EBM), primarily generated by medical science investigation. Randomized controlled trials (RCTs) are considered the gold standard of investigational studies, though other forms of study are valid. RCTs and their systemic reviews via meta-analysis give averaged data; they can be definitive or non-definitive and may fail to account for outlier results. The use of EBM data to the PDLS surgeon often is limited within the setting of the examining room. Over-reliance on such data can have detrimental effects on the patient-care process.The rise of surgical spine-care expense has outpaced that of the general national healthcare. This is primarily the result of the increasing use of instrumentation [for fusion]. Instrumentation/fusion technology has benefitted many patients. However, the multibillion dollar industry of its use has corrupted the process establishing clinical indications and efficacy. This has been done mainly by incorporating the surgeon into the corporate profit stream, establishing significant conflict of interest (COI) scenarios within product investigational research.The fundamental solution to the exponential rise in over-all healthcare expense entails the conversion of its economic model into one that establishes a diagnostic unit of purchase, as apposed to the present interventional one. And in spinal surgery, the instrumentation/fusion industry must be removed, financially, from the process of product investigation and validation.