An article published in Spine examines the cost-effectiveness of anterior cervical discectomy and fusion as well as cervical disc replacement at five years using the Markov analysis.
The researchers examined data from patients who underwent ACDF or cervical disc replacement. Physician costs were based on a fixed percentage of 140 percent of 2010 Medicare reimbursement and hospital costs were determined using the Nationwide Inpatient sample data. For the disc replacement, researchers examined data using the ProDisc-C trial.
Here are five key findings from the study:
1. The costs were significantly higher for ACDF after five years:
• Cervical disc replacement — $102,274
• ACDF — $119,814
2. Quality-adjusted life years for both procedures were relatively similar five years after surgery. Disc replacement was associated with 2.84 QALY while ACDF was associated with 2.81 QALY.
3. The incremental cost-effectiveness ratio was –$557,849 per quality-adjusted life year gained.
4. The ACDF was a cost-effective strategy below a cost of $18,607. However, cervical disc replacement was the dominant strategy below a cost of $20,486.
5. Disc replacement was the dominant strategy when the utility value was above 0.713 and remained the dominant strategy with an annual complication rate of less than 4.37 percent.
6. Both procedures were ultimately deemed cost-effective by the study's authors at five years.