{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T14:09:27Z","timestamp":1790690967602,"version":"4.1.0"},"reference-count":22,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T00:00:00Z","timestamp":1790467200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T00:00:00Z","timestamp":1790467200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Global Spine Journal"],"abstract":"<jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>Decision-analytic cost-effectiveness analysis using a Markov state-transition model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Lumbar spinal stenosis (LSS) is the most common indication for spine surgery in older adults. Minimally invasive surgery (MIS) tubular decompression and open laminectomy produce equivalent one-year outcomes, but their long-term cost-effectiveness for pure decompression is unknown. We modeled 10-year cost-effectiveness from the U.S. payer perspective.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We built a five-state Markov model for a simulated cohort of 10,000 patients aged 65 with pure LSS (no instability, deformity, spondylolisthesis, or prior surgery), using 3-month cycles, a 10-year horizon, and 3% annual discounting. QALYs used SPORT EQ-5D utilities. Perioperative complication rates came from the Nerland 2015 propensity-matched cohort (10.6% vs. 14.6%; risk difference 4.1 percentage points, 95% CI -2.6 to 10.7). Recurrence, postoperative utility, and perioperative mortality were equalized across arms. One-way, threshold, and probabilistic sensitivity analyses (PSA) were performed, including wide-uncertainty sampling of the complication difference across its confidence interval.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>MIS yielded 5.95 QALYs at $26,283 versus 5.91 QALYs at $30,450 for open laminectomy, saving $4,167 per patient (MIS dominant). MIS was cost-effective in 81% of PSA iterations at $50,000\/QALY and in 82% to 88% under wide-uncertainty sampling, and remained cost-effective at $100,000\/QALY unless its complication rate exceeded 17.5%. Without any complication advantage, MIS still saved $3,454 with equal QALYs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>For pure LSS, MIS tubular decompression was cost-effective and, in the base case, dominant over open laminectomy. The advantage reflects the complication difference and the lower index cost, and should inform rather than determine coverage policy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/21925682261494612","type":"journal-article","created":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T12:04:36Z","timestamp":1790510676000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Cost-Effectiveness of Minimally Invasive Tubular vs. Open Laminectomy for Pure Lumbar Spinal Stenosis: A Markov State-Transition Analysis"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8611-6711","authenticated-orcid":false,"given":"Rohan A.","family":"Phadke","sequence":"first","affiliation":[{"name":"Baylor College of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-9897-4071","authenticated-orcid":false,"given":"Samer G.","family":"Salman","sequence":"additional","affiliation":[{"name":"Baylor College of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-9979-2448","authenticated-orcid":false,"given":"Imaad","family":"Virani","sequence":"additional","affiliation":[{"name":"Baylor College of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-5693-2751","authenticated-orcid":false,"given":"James","family":"Burnett","sequence":"additional","affiliation":[{"name":"Baylor College of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maryam Y.","family":"Jawid","sequence":"additional","affiliation":[{"name":"Baylor College of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arnav","family":"Kak","sequence":"additional","affiliation":[{"name":"Baylor College of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Mihas","sequence":"additional","affiliation":[{"name":"Baylor College of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenzo","family":"Deveza","sequence":"additional","affiliation":[{"name":"Baylor College of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,27]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2022.5921"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.h6234"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1227\/NEU.0000000000000943"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000000731"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.h1603"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-025-28949-9"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000001161"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e31820c97b1"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1513721"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000000562"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jval.2021.11.1351"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000000571"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.3171\/2011.9.SPINE11308"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.14444\/5076"},{"key":"e_1_3_3_16_2","unstructured":"Arias E Xu J. 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