{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T09:35:02Z","timestamp":1785404102918,"version":"3.56.0"},"reference-count":22,"publisher":"The Journal of Health Economics and Outcomes Research","issue":"1","license":[{"start":{"date-parts":[[2022,3,25]],"date-time":"2022-03-25T00:00:00Z","timestamp":1648166400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["jheor.org"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec id=\"background\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Given the increased attention to functional improvement in spine surgery as it relates to motion preservation, activities of daily living, and cost, it is critical to fully understand the healthcare economic impact of new devices being tested in large FDA randomized controlled trials (RCT). The purpose of this analysis was to comprehensively evaluate the cost-effectiveness of the novel Total Posterior Spine (TOPS\u2122) System investigational device compared with the trial control group, standard transforaminal lumbar interbody fusion (TLIF).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"objective\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the cost-effectiveness of TOPS\u2122 compared with TLIF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"methods\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The study patient population was extracted from a multicenter RCT with current enrollment at n=121 with complete 1-year follow-up. The primary outcome was cost-effectiveness, expressed as the incremental cost-effectiveness ratio. Secondary outcomes were health-related utility, presented as quality-adjusted life-years (QALYs), and cost, calculated in US dollars. Analysis was conducted following Second Panel on Cost-Effectiveness Health and Medicine recommendations. The base case analysis utilized SF-36 survey data from the RCT. Both cost and QALY outcomes were discounted at a yearly rate of 3% to reflect their present value. A cohort Markov model was constructed to analyze perioperative and postoperative costs and QALYs for both TOPS\u2122 and control groups. Scenario, probabilistic, and threshold sensitivity analyses were conducted to determine model discrimination and calibration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"results\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The primary time horizon used to estimate cost and health utility was 2 years after index surgery. From a health system perspective, assuming a 50\/50 split between Medicare and private payers, the TOPS\u2122 cohort is cost-effective 2 years postoperatively ($6158\/QALY) compared with control. At 6 years and beyond, TOPS\u2122 becomes dominant, irrespective of payer mix and surgical setting. At willingness-to-pay thresholds of $100\u202f000\/QALY, 63% of all 5000 input parameter simulations favor TOPS, even with a $4000 upcharge vs TLIF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"discussion\">\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>The novel TOPS\u2122 device is cost-effective compared with TLIF and becomes the dominant economic strategy over time.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"conclusions\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In the emerging, rapidly expanding field of value-based medicine, there will be an increased demand for these analyses, ensuring surgeons are empowered to make the best, most sustainable solutions for their patients and society.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.36469\/001c.33035","type":"journal-article","created":{"date-parts":[[2022,3,25]],"date-time":"2022-03-25T09:16:04Z","timestamp":1648199764000},"update-policy":"https:\/\/doi.org\/10.36469\/00001","source":"Crossref","is-referenced-by-count":0,"title":["A Prospective Study of Lumbar Facet Arthroplasty in the Treatment of Degenerative Spondylolisthesis and Stenosis: Early Cost-effective Assessment from the Total Posterior Spine System (TOPS\u2122) IDE Study"],"prefix":"10.36469","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3252-8769","authenticated-orcid":false,"given":"Jared D.","family":"Ament","sequence":"first","affiliation":[{"name":"Cedars Sinai Medical Center, Los Angeles, California; Neuronomics LLC, Los Angeles, California; Neurosurgery & Spine Group, Los Angeles, California; Institute of Neuro Innovation, Santa Monica, California; Sierra Neuroscience Institute, Glendale, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amir","family":"Vokshoor","sequence":"additional","affiliation":[{"name":"Neuronomics LLC, Los Angeles, California; Neurosurgery & Spine Group, Los Angeles, California; Institute of Neuro Innovation, Santa Monica, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaser","family":"Badr","sequence":"additional","affiliation":[{"name":"Sierra Neuroscience Institute, Glendale, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Todd","family":"Lanman","sequence":"additional","affiliation":[{"name":"Cedars Sinai Medical Center, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kee D.","family":"Kim","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/05rrcem69","id-type":"ROR","asserted-by":"publisher"}],"name":"University of California, Davis"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. Patrick","family":"Johnson","sequence":"additional","affiliation":[{"name":"Cedars Sinai Medical Center, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"22273","published-online":{"date-parts":[[2022,3,25]]},"reference":[{"issue":"12","key":"ref1","doi-asserted-by":"publisher","first-page":"1231","DOI":"10.1001\/jamasurg.2014.716","article-title":"Cost-effectiveness of cervical total disc replacement vs fusion for the treatment of 2-level symptomatic degenerative disc disease","volume":"149","author":"Jared D. Ament","year":"2014","journal-title":"JAMA Surgery","ISSN":"https:\/\/id.crossref.org\/issn\/2168-6254","issn-type":"print"},{"issue":"1","key":"ref2","doi-asserted-by":"publisher","first-page":"E4","DOI":"10.3171\/2012.4.focus1288","article-title":"Standardizing cost-utility analysis in neurosurgery","volume":"33","author":"Jared D. 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