The New Era of Cost Analysis in Spine Surgery Utilizing Time-Driven Activity Based Costing: A Systematic Review and Introduction of an Enabling Technology Value Index
Spine Surgeon Virginia Mason Medical Center Virginia Mason Medical Center
Disclosure(s):
Philip K. Louie, MD: No relevant disclosure to display
Introduction: This systematic review summarizes the growing applications of TDABC in spine care and introduces a value index in which TDABC can be applied to rigorously evaluate innovations in a reproducible and accurate fashion.
Methods: The authors performed a systematic literature search of the PubMed and Embase databases using search terms related to spine surgery and TDABC. Studies describing the application of TDABC analysis to any aspect of the episode of care surrounding spinal pathology were included. This review adhered to the Preferred Reporting Items for Systematic Review (PRISMA) guidelines.
Results: From 33 identified studies, 10 were included after exclusions. Four studies focused on anterior cervical discectomy and fusion (ACDF), four on single-level lumbar fusion, one on a multidisciplinary spine conference, and one on outpatient spine clinic care. Comparative analyses in the ACDF and lumbar fusion studies identified key cost drivers, including case volume, number of levels fused, intraoperative magnification, patient BMI, discharge timing, and screw navigation methods. Process mapping was primarily conducted using electronic medical records (EMR), direct observation, and third-party resources. Total cost estimates ranged from $201.78 per patient for a spine conference to $30,566 for two-level ACDF. Major cost drivers were materials/implants, operating room time, and hospitalization duration, with unnecessary outpatient referrals and reduced complication rates in multidisciplinary conferences also highlighted as significant findings. An enabling technology value index algorithm was proposed in which costing, as measured by TDABC methods, serves as the costing arm and denominator for the value analysis.
Conclusion : TDABC has demonstrated its utility in accurately calculating costs and identifying meaningful variability across different spine surgery contexts. As value-based care models evolve, integrating TDABC can align cost-efficiency with quality care, particularly in evaluating enabling technologies. Despite potential implementation barriers, TDABC offers a robust framework for resource allocation and enhancing the value of spine care.