Table 5

Summary of economic evaluation.

Study	Study Type & Data Source	Country	Economic Perspective	Discount Rate	Indirect Costs?	Total Cost	Difference Between MIS and Open Cost (% Difference)^a	MIS Cost per QALY^b	Open Surgery Cost per QALY^b	Change in QALY
Slotman 199812	RC cost analysis from hospital charges database	USA	Payer (user charges)	NR	N	MIS: 5723 (IP) : 4405 (OP)	IP: 1469 (20.4%) OP: 2787 (38.8% P < 0.01)	NR	NR	NR
Slotman 199812	RC cost analysis from hospital charges database	USA	Payer (user charges)	NR	N	Open: 7192	IP: 1469 (20.4%) OP: 2787 (38.8% P < 0.01)	NR	NR	NR
VD Akker 201113	CEA using Euro QOL 5D from randomized controlled trial	Holland	Societal (direct + indirect)	0%	Y	MIS: €33,706	€2972 (19.6%)	42,665	38,321	MIS: 0.790
VD Akker 201113	CEA using Euro QOL 5D from randomized controlled trial	Holland	Societal (direct + indirect)	0%	Y	Open: €30,734	€2972 (19.6%)	42,665	38,321	Open: 0.802 (P = 0.47)
Lucio 201214	PNRC cost analysis from hospital charges database	USA	Payer (user charged)	N/A	N	MIS: 24,320	2735 (10.1%) (P = 0.029)	NR	NR	NR
Lucio 201214	PNRC cost analysis from hospital charges database	USA	Payer (user charged)	N/A	N	Open: 27,055	2735 (10.1%) (P = 0.029)	NR	NR	NR
Parker 201215	PNRC CEA using Euro QOL 5D	USA	Payer (user charges)	N/A	Y	MIS: 35,996	8731 (19.5%) (P = 0.18)	71,992	109,090	MIS: 0.5
Parker 201215	PNRC CEA using Euro QOL 5D	USA	Payer (user charges)	N/A	Y	Open: 44,727	8731 (19.5%) (P = 0.18)	71,992	109,090	Open: 0.41 (P = 0.17)
Wang 201216	RC cost analysis	USA	Payer (Medicare/user charges)	N/A	N	MIS: 70,159 (SL) 87,454 (TL)	SL: 8285 (10.6%) (P = 0.027)	NR	NR	NR
Wang 201216	RC cost analysis	USA	Payer (Medicare/user charges)	N/A	N	Open: 78,444 (SL) 108,843 (TL)	TL: 21,389 (19.7%) (P = 0.071)	NR	NR	NR
Pelton 201217	PNRC cost analysis	USA	Payer (user charges)	N/A	Y	MIS: 28,060 (WC) 29,429 (NWC)	WC: 5602 (17.1%) (P = 0.031)	NR	NR	NR
Pelton 201217	PNRC cost analysis	USA	Payer (user charges)	N/A	Y	Open: 33,862 (WC) 32,998 (NWC)	NWC: 3569 (10.8%)(P < 0.001)	NR	NR	NR
Udeh 201218	Cost-utility analysis using Euro QOL 5D and decision model analysis	USA	Payer (Medicare/user charges)	3%	N	MIS: 5458	8313 (60.3%)	43,760	125,985	MIS: 0.131
Udeh 201218		USA	Payer (Medicare/user charges)	3%	N	Open: 13,771	8313 (60.3%)	43,760	125,985	Open: 0.17
Cahill 201319	RC cost analysis from hospital charges database	USA	Payer (user charges)	N/A	N	MIS: 22,358	5576 (19.6%) (P = 0.01)	NR	NR	NR
Cahill 201319	RC cost analysis from hospital charges database	USA	Payer (user charges)	N/A	N	Open: 27,811	5576 (19.6%) (P = 0.01)	NR	NR	NR
Parker 201320	RC CEA	USA	Payer (Medicare/user charges)	N/A	Y	MIS: 23,109	2311 (9.0%) P = 0.21	32095.8	35305.8	MIS: 0.36
Parker 201320	RC CEA	USA	Payer (Medicare/user charges)	N/A	Y	Open: 25,420	2311 (9.0%) P = 0.21	32095.8	35305.8	Open: 0.36
Singh 201321	PNRC cost analysis from hospital costs database	USA	Hospital costs	N/A	N	MIS: 19,512	4038 (17.1%) (P < 0.001)	NR	NR	NR
Singh 201321	PNRC cost analysis from hospital costs database	USA	Hospital costs	N/A	N	Open: 23,550	4038 (17.1%) (P < 0.001)	NR	NR	NR
Parker 201422	CEA using Euro QOL 5D from PNRC	USA	Payer (Medicare/user charges)	N/A	Y	MIS: 27,621	821 (2.9%) P = 0.5	35,825	40,924	MIS: 0.77
Parker 201422	CEA using Euro QOL 5D from PNRC	USA	Payer (Medicare/user charges)	N/A	Y	Open: 28,442	821 (2.9%) P = 0.5	35,825	40,924	Open: 0.69 (P > 0.05)
Sulaiman 201423	RC cost analysis from hospital charges database	USA	Hospital costs	N/A	N	MIS: 19,078	18,603 (49.4%)	NR	NR	NR
Sulaiman 201423	RC cost analysis from hospital charges database	USA	Hospital costs	N/A	N	Open: 37,681	18,603 (49.4%)	NR	NR	NR
Maillard 201424	RC cost-minimization study (cost-effectiveness measured by hospital cost vs reimbursement)	France	Hospital costs	N/A	N	MIS: €7893	2180 (21.6%)	1139 gain per patient^c	620 loss per patient^a ( P = 0.021)	NR
Maillard 201424		France	Hospital costs	N/A	N	Open: €10,073	2180 (21.6%)	1139 gain per patient^c	620 loss per patient^a ( P = 0.021)	NR
R’saud 201525	RC CEA using Euro QOL 5D	Canada	Hospital costs	5%	N	MIS: 14,183	4450 (23.9%) P = 0.0009	70,915 (2 y)	122,585 (2 y)	MIS: 0.113
R’saud 201525	RC CEA using Euro QOL 5D	Canada	Hospital costs	5%	N	Open: 18,633	4450 (23.9%) P = 0.0009	70,915 (2 y)	122,585 (2 y)	Open: 0.079 (P = 0.08)
Vertuani 201526	CEA using Euro QOL 5D & decision model analysis	UK/Italy^d	Payer (user charged)	N/A	N	MIS: €13,399 (UK) €10,012 (Italy)	UK: 1666 (11.4%)	UK MIS €18,609	UK open: €22,154	NR
Vertuani 201526	CEA using Euro QOL 5D & decision model analysis	UK/Italy^d	Payer (user charged)	N/A	N	Open: €15,065 (UK): €10,985 (Italy)	Italy: 973 (8.9%)	Italy MIS: €13,903	Italy open: €16154.41	NR
G’hoke 201627	RC CEA using Euro QOL 5D	USA	Societal	N/A	Y	MIS: 45,574	1506 (3.3%) (P = 0.96)	75956.67	65773.13	MIS: 0.60
G’hoke 201627	RC CEA using Euro QOL 5D	USA	Societal	N/A	Y	Open: 44,068	1506 (3.3%) (P = 0.96)	75956.67	65773.13	Open: 0.67 (P = 0.3)
Djurasovic 201928	PNRC using EQ-5D and SF-6D from prospective hospital database	USA	Hospital costs	n/a	N	MIS: 15,867	1745 (9.9%)	101,711	124907.80	MIS: 0.156
Djurasovic 201928		USA	Hospital costs	n/a	N	Open: 17,612	1745 (9.9%)	101,711	124907.80	Open: 0.141

Abbreviations: CEA, cost-effectiveness analysis; IP, inpatient; MIS, minimally invasive surgery; NR, not reported/recorded discounted rate; NWC, no workers compensation; OP, outpatient (home on day of surgery); PNRC, prospective nonrandomized cohort study; QALY , quality adjusted life year; RC, retrospective cohort study; SL, single level; TL, two level; WC, workers compensation.
↵a Standard denotes that MIS total cost is less than that of open procedure. Bold font denotes that MIS total cost is more than that of open procedure.
↵b In USD unless otherwise stated.
↵c Maillard et al measured cost-effectiveness as the difference between cost and hospital reimbursement.
↵d UK costs were taken from the UK NHS reference cost list (2015). Costs for Italy and the unit cost estimates for surgical equipment and consumables were obtained from a microcosting study performed in 2 Italian hospitals (ref).