Advocating uniformity in spine surgery: a practical disease-specific guideline for trial-based economic evaluations

Abstract

Objectives: Despite the availability of general and national guidelines for the conduct and reporting of economic evaluations, there is heterogeneity in economic evolutions concerning spine surgery. This is partly the result of differing levels of adherence to the existing guidelines and the lack of disease-specific recommendations for economic evaluations. The extensive heterogeneity in study design, follow-up duration and outcome measurements limit the comparability of economic evaluations in spine surgery. This study has three objectives: (1) to create disease-specific recommendations for the design and conduct of trial-based economic evaluations in spine surgery, (2) to define recommendations for reporting economic evaluations in spine surgery as a complement to the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022 checklist and (3) to discuss methodological challenges and defining the need for future research.

Design: A modified Delphi method according to the RAND/UCLA Appropriateness Method.

Setting: A four-step process was followed to create and validate disease-specific statements and recommendations for the conduct and reporting of trial-based economic evaluations in spine surgery. Consensus was defined as >75% agreement.

Participants: A total of 20 experts were included in the expert group. Validation of the final recommendations was obtained in a Delphi panel, which consisted of 40 researchers in the field who were not included in the expert group.

Primary and secondary outcome measures: The primary outcome measure is a set of recommendations for the conduct and reporting, as a complement to the CHEERS 2022 checklist, of economic evaluations in spine surgery.

Results: A total of 31 recommendations are made. The Delphi panel confirmed consensus on all of the recommendations in the proposed guideline.

Conclusion: This study provides an accessible and practical guideline for the conduct of trial-based economic evaluations in spine surgery. This disease-specific guideline is a complement to existing guidelines, and should aid in reaching uniformity and comparability.

Keywords: health economics; protocols & guidelines; spine.

Figure 1

Flowchart of the steps of the modified Delphi process.

Figure 2

Level of agreement per statement. Percentage (%) of agreement (left). Level of relevance (right) per statement, indicated with a score from 0 (irrelevant) to 3 (extremely relevant). The red line indicates the cut-off for consensus (>75% agreement).

Figure 3

Level of agreement on final statements. Indicated per statement in percentage (%). The green line indicates the cut-off for consensus (>75% agreement).