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Spine (Phila Pa 1976). 2014 Nov 1;39(23):1924-33. doi: 10.1097/BRS.0000000000000562.

The 5-year cost-effectiveness of anterior cervical discectomy and fusion and cervical disc replacement: a Markov analysis.

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1
*Department of Orthopaedic Surgery, Mount Sinai Medical Center, New York, NY; and †Texas Back Institute/Texas Health Research Institute, Plano, TX.

Abstract

STUDY DESIGN:

A Markov state-transition model was developed to evaluate the cost-effectiveness of anterior cervical discectomy and fusion (ACDF) and cervical disc replacement (CDR) at 5 years.

OBJECTIVE:

To determine the cost-effectiveness of ACDF and CDR at 5 years.

SUMMARY OF BACKGROUND DATA:

ACDF and CDR are surgical options for the treatment of an acute cervical disc herniation with associated myelopathy/radiculopathy. Cost-effectiveness analysis provides valuable information regarding which intervention will lead to a more efficient utilization of health care resources.

METHODS:

Outcome and complication probabilities were obtained from existing literature. Physician costs were based on a fixed percentage of 140% of 2010 Medicare reimbursement. Hospital costs were determined from the Nationwide Inpatient Sample. Utilities were derived from responses to health state surveys (Short Form 36) at baseline and at 5 years from the treatment arms of the ProDisc-C trial. Incremental cost-effectiveness ratios were used to compare treatments. One-way sensitivity analyses were performed on all parameters within the model.

RESULTS:

CDR generated a total 5-year cost of $102,274, whereas ACDF resulted in a 5-year cost of $119,814. CDR resulted in a generation of 2.84 quality-adjusted life years, whereas ACDF resulted in 2.81. The incremental cost-effectiveness ratio was -$557,849 per quality-adjusted life year gained. CDR remained the dominant strategy below a cost of $20,486. ACDF was found to be a cost-effective strategy below a cost of $18,607. CDR was the dominant strategy when the utility value was above 0.713. CDR remained the dominant strategy assuming an annual complication rate less than 4.37%.

CONCLUSION:

ACDF and CDR were both shown to be cost-effective strategies at 5 years. CDR was found to be the dominant treatment strategy in our model. Further long-term studies evaluating the clinical and quality-of-life outcomes of these 2 treatments are needed to further validate the model.

LEVEL OF EVIDENCE:

5.

PMID:
25188602
DOI:
10.1097/BRS.0000000000000562
[Indexed for MEDLINE]

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