Economics of cervical disc replacement

Abstract

Background: Although extensive reports of clinical outcome after cervical disc replacement (CDR) and anterior cervical discectomy and fusion exist, few reviews of the cost-effectiveness research in cervical spine surgery exist. The purpose of this study was to review the concepts of cost-effectiveness research, the various approaches to cost-effectiveness studies in the context of cervical spine surgery, and some of the literature results. Methods: Review article describing cost-effectiveness research concepts, methodology, and results. The article reviews the concept of value, cost, utility, incremental cost-effectiveness ratio, and recent research. Results: Mixed data on cost-effectiveness of CDR compared with fusion exist. Notably, several studies performed within the last 5 years that use prospectively collected utility scores, costs, and adverse event calculations demonstrate a significant cost savings associated with CDR compared with fusion. Conclusions: The recent literature confirms that, in properly selected patients, CDR is more effective and less costly over a 7-year time horizon for patients with symptomatic degenerative disc disease. The primary driver of the differential in cost effectiveness is the difference in secondary surgery rates.