ACDFs have 'unacceptably poor cost-utility' in hospitals

Spine

Anterior cervical discectomy and fusion costs significantly less when performed in ASCs than the hospital setting for Medicare and privately insured patients, according to a study published in the Dec. 15 edition of Spine.

Researchers examined data from 6,504 patients from the Quality Outcomes Database who underwent one and two level fusions. There were 520 patients who underwent the surgery in ASCs compared with 5,984 patients who had their procedures done in a hospital. The study authors identified 748 patients for the analysis, 374 per cohort, after propensity matching.

Four findings:

1. Total costs for spinal fusion in the ASC at one year were $5,879.46, compared with $12,873.97 for procedures in the hospital.

2. The inpatient ACDF incremental cost-effectiveness ratio was $3,674,662 for Medicare patients and $8,046,231 for privately insured patients. The results showed "unacceptably poor cost-utility," according to the study authors.

3. Complication rates, patient-reported outcome measures and QALYs were similar for the patients who underwent surgery at the hospital and ASC.

4. Study authors concluded, "The ASC setting is a dominant option from a health economy perspective for first-time onelevel to two-level ACDF in select patients compared to the inpatient hospital setting."

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