The Budget Impact of Introducing Intraoperative Imaging System With Navigation for Spinal Fusion Procedures in Spain

OBJECTIVES: In recent years, the importance of intraoperative navigation in spinal surgery has been increasing, with multiple studies proving the advantages and safety of computer-assisted procedures. We aimed to estimate the economic impact of navigated spine surgery in combination with a multidimensional imaging system from a Spanish, tertiary hospital perspective considering a 10-year time horizon.

METHODS: A cost analysis was developed based on previously published evidence to assess the budget impact associated with replacing on a 1:1 basis conventional fluoroscopy with image-guided navigation for spinal fusion procedures regardless of the indication. Unit costs, obtained from different Spanish sources and expressed in €2024, were applied to health resource consumption comprising equipment, consumables, maintenance, surgical procedure, postoperative hospitalization and computed tomography scans, postoperative screw revisions and surgical site infections. The model inputs were validated by a clinical expert. To assess the reliability of the results, a deterministic sensitivity analysis was performed, which involved adjusting unit costs.

RESULTS: For each treatment group, 150 procedures were considered annually over 10 years. Estimated mean total costs per patient undergoing image-guided or fluoroscopy-assisted surgery were €10,002 and €10,326, respectively, resulting in mean total cost savings of €324 per patient. The acquisition cost of image-guided navigation system was outweighed mainly by the cost savings associated with potential reduced need for revision procedures and shorter length of stay, which resulted in a cost decrease per patient of €858 and €575, respectively. These savings allowed a return on the capital investment within six years of acquisition. Considering the total population, the results projected savings of €485,574 in 10 years. The model's reliability was confirmed through sensitivity analyses.

CONCLUSIONS: From a Spanish hospital perspective, upfront costs of image-guided navigated spine surgery were estimated to be totally offset before the sixth year of investment in comparison with conventional fluoroscopy.