STUDY TYPE
Cost-utility analysis of patients contributed to a randomized controlled trial.
INTRODUCTION
Patients with cervical disc herniations resulting in radiculopathy or myelopathy from
single-level disease have traditionally been treated with anterior cervical discectomy
and fusion (ACDF) with excellent results. Cervical disc arthroplasty (CDA) has been
shown to result in similar clinical outcomes. Expert suggestion of reduced adjacent
segment degeneration is a promising future result. To our knowledge, a cost-utility
analysis of these procedures with long-term follow-up has not been previously reported.
OBJECTIVES
To compare the cost-utility of ACDF versus CDA in single-level cervical disc disease.
To structure future research of the cost-utility over a long-term follow-up for these
alternative surgical options.
METHODS
We reviewed single institution prospective data from a randomized trial comparing
single-level ACDF and CDA in cervical disc disease [1]. Data collected included demographics, Health-Related Quality of Life outcome scores
(neck disability index [NDI] and SF-36), and quality-adjusted life year (QALY) utility
scores. The QALYs were calculated at 1 and 2 years after surgery based on accepted
methodology [2], [3] allowing for cost/QALY assessment. Procedural cost was estimated via Medicare reimbursement
based on diagnosis related groups (DRG) and physician current procedural terminology
(CPT) codes.
RESULTS
Patients included ACDF (n = 10) and CDA (n = 18) with no significant difference in
demographic data (Table [1]). Both groups showed improvement in NDI. Both groups showed improvement in all domains
of SF-36 except general health, which remained stable. The ACDF patients recorded
significantly higher scores in the mental health domain at 1 and 2 years (P < .05).
At 2 years, total QALYs gained were for ACDF, 0.37 and CDA, 0.27 when calculated using
NDI; ACDF, 0.47 and CDA, 0.32 when using SF-36 (Table [2]). The average cost of ACDF was $16,162, while CDA averaged $13,171. Cost/QALY was
for ACDF, $43,681 and CDA, $48,781 at 2 years based on NDI. Cost/QALY was for ACDF,
$34,387 and CDA, $41,159 at 2 years based on SF-36.
No conflict of interest.
IRB approved study NYU.
This device is FDA approved for the use evaluated in this study.
The incremental cost-effectiveness ratios of ACDF versus CDA were $29,910 and $19,940
when calculated with NDI and SF-36, respectively (Table [3]).
CONCLUSIONS
We confirm the efficacy of ACDF and CDA in the treatment of cervical disc disease.
Our results suggest similar clinical outcomes at 1- and 2-year follow-up. Both modalities
demonstrate cost-effectiveness. However, the additional QALYs gained by ACDF in this
study demonstrate a potentially more cost-effective profile at 2 years. The incremental
cost-effectiveness ratio suggests that the added benefit via ACDF comes at a reasonable
cost.
Long-term follow-up may illustrate greater cost-effectiveness via CDA due to lower
cost based on this financial model and potential economic treatment dominance over
ACDF.
