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

Steven J. McAnany, Samuel Overley, Evan O. Baird, Samuel K. Cho, Andrew C. Hecht, Jack E. Zigler, Sheeraz A. Qureshi

Research output: Contribution to journalArticlepeer-review

52 Scopus citations

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 costeffective 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.

Original languageEnglish
Pages (from-to)1924-1933
Number of pages10
JournalSpine
Volume39
Issue number23
DOIs
StatePublished - 2014

Keywords

  • Anterior cervical discectomy and fusion
  • Cervical disc replacement
  • Cost-effectiveness
  • Markov model

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