Defining the value of elective lumbar fusion: a systematic review of existing methodologies and framework for the Operative Value Index - PubMed

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The review aimed to characterize existing cost-effectiveness metrics for lumbar fusion, evaluate time-driven activity-based costing (TDABC) in spine surgery, and outline a standardized Operative Value Index (OVI).
Among 366 screened studies, 40 met inclusion criteria: 21 for cost-effectiveness in lumbar fusion and 19 for TDABC in spine surgery.
The incremental cost-effectiveness ratio (ICER) was the most common cost-effectiveness metric, followed by OVI, with costs often based on reimbursement or charges, not actual costs.
TDABC studies found that costs were primarily driven by surgeon-level and procedure-specific factors rather than patient characteristics.
OVI studies used TDABC costs with disease-specific outcomes but were limited by short-term follow-up and a focus on intraoperative costs.
Current value assessments in lumbar fusion face limitations due to heterogeneous outcomes and imprecise costing, suggesting a need for a standardized framework integrating pathology-specific outcomes and episode-level costing.

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