Table 3.
Summary of Significant Studies Reporting on the Cost-Effectiveness of IONM Techniques.
| Reference | Year | Design | Type of Monitoring | No. of Cases | Type of Cases | Conclusions |
|---|---|---|---|---|---|---|
| Sala et al | 2007 | Cost-benefit analysis | ND | ND | Scoliosis surgery | Considering injury rate of 0.1%, IONM would be cost-effective if the costs did not exceed $977 per surgery given the lifetime direct health care costs for a paraplegic patient. |
| Ayoub et al | 2010 | Retrospective review | SSEP | 210 | Cervical spine | Cost savings to the hospital was $64 074 to $102 192 per patient injured per year at an expense of $31 546 per year on SSEP monitoring. |
| Ney et al | 2012 | Hypothetical cost- effectiveness model | ND | ND | ND | IONM was associated with a 49% reduction in in relative risk for neurological complications. The cost of monitoring to prevent a single neurologic injury was $63 387. |
| Ney et al | 2013 | Hypothetical cost-effectiveness model | ND | ND | ND | MIONM was found to be cost-effective when neurologic complication rate from surgery exceeded 0.3%. |
| Traynelis et al | 2012 | Retrospective review | SSEP, MEP | 720 | Cervical spine | Significant savings of more than $1 million in the study cohort by not using IONM in simple cervical spine procedures. |
| Ney et al | 2018 | Retrospective review | Combination of SSEP, MEP, or EMG | 8413 | Single-level cervical spine | Initially found to have greater cost with IONM. However, it was found to be cost-effective in the year after surgery, with a net decrease in cost of $387 per patient. |
| Cole et al | 2014 | Retrospective review | Combination of SSEP, MEP, or EMG | 85 640 | Single-level spinal procedures | IONM was associated with higher spending, ranged from $2859 to $3841. |
| Ney et al | 2015 | Retrospective analysis | Combination of SSEP, MEP, or EMG | 234 067 (unweighted observations) | Simple spinal decompressions and fusions | IONM was associated with fewer neurologic complications and 9% increased hospital charges. |
Abbreviations: IONM, intraoperative neurophysiological monitoring; ND, not determined; SSEP, somatosensory sensory evoked potential; MIONM, multimodal intraoperative neurophysiological monitoring; MEP, motor-evoked potential; EMG, electromyography.