A new study published in The Spine Journal examined how obesity can affect the cost per quality adjusted life years gained after anterior cervical discectomy and fusion.
The study authors are Silky Chotai, MD, J. Alex Sielatycki, MD, Scott Parker, MD, Ahilan Sivaganesan, MD, Harrison Kay, MD, David Stonko, MS, Joseph Wick, Matthew McGirt, MD, and Clinton Devin, MD. They examined the one and two-year medical resource utilization, missed work and health state values for patients who underwent elective ACDF for degenerative cervical pathology at an academic institution.
The study authors reported:
1. The pain, disability and quality of life scores showed significant improvement two years after surgery.
2. There wasn't significant difference between the obese and non-obese patients in:
• Healthcare resource utilization
• Direct cost
• Indirect cost
• Total cost
3. The average direct cost for obese patients was $19,225; the average cost for non-obese patients was slightly lower at $17,635. The average total two year cost for the obese patients was $23,144, similar to the total overall cost for non-obese patients at $22,183.
4. The obese patients reported lower average cumulative QALY gain when compared with the non-obese patients. Obese patients reported 0.34 QALY gain versus 0.42 QALY gained for non-obese patients.
5. For obese patients, the two-year cost-utility was $68,070 compared with $52,816 in the non-obese patients. However, the difference was not significantly.
6. The morbidly obese patients reported a lower 0.17 QALYs gained and a higher cost per QALYs gained at the two-year mark.
"Morbidly obese patients had lower cost-effectiveness; however surgery does provide a significant improvement in outcomes," concluded the study authors. "Obesity, and specifically morbid obesity, should be taken into consideration as physicians and hospital reimbursement move toward a bundled model."