Cost-utility analysis of anterior cervical discectomy and fusion versus cervical disc arthroplasty

Abstract

BACKGROUND CONTEXT: Patients with cervical disc herniations resulting in radiculopathy ormyelopathy fromsingle 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.ACost-UtilityAnalysis of these procedures with long-term follow-up has not been previously reported. PURPOSE: To compare the cost-utility of ACDF vs. 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. STUDY DESIGN/SETTING: Single institution review of a randomized controlled trial comparing ACDF to CDA in the setting of single level cervical disc disease with the performance of a cost-utility analysis. PATIENT SAMPLE: 28 patients (ACDF n510, CDA n518) who underwent surgery as part of a randomized controlled trial. OUTCOME MEASURES: Clinical outcome scores (neck disability index, SF-36) and direct treatment costs. METHODS: We reviewed single institution prospective data from a randomized trial comparing single-level ACDF and CDA in cervical disc disease. Data collected included demographics, outcome scores (NDI and SF-36), and utility scores. Procedural cost was estimated via medicare reimbursement based on DRG and physician CPT codes. QALYs were calculated at 1 and 2 years after surgery, allowing for cost/QALYassessments. RESULTS: Patients included ACDF (n510) and CDA (n518) with no significant difference in demographic data. Both groups showed improvement in NDI. Both groups showed improvement in all domains of SF-36 except general health (GH), which remained stable. ACDF patients recorded significantly higher scores in the mental health (MH) domain at 1 and 2 years (p