Cost-effectiveness of single-level anterior cervical discectomy and fusion five years after surgery

Brief review

*Title: Cost-effectiveness of single-level anterior cervical discectomy and fusion five years after surgery

단일분절 전방경유 경추 절제 및 유합술 후 5년 간의 비용 효율성

*Authors: Leah Y. Carreon, Paul A. Anderson, Vincent C. Traynelis, Praveen V. Mummaneni, Steven D. Glassman

*Bibliography: Spine (Phila Pa 1976). 2013 Mar15;38(6):471-5.

STUDY DESIGN

Longitudinal cohort

OBJECTIVE

To determine the cost per quality-adjusted life year(cost/QALY) gained for single-level instrumented anterior cervical discectomy and fusion(ACDF) over 5 years.

SUMMARY OF BACKGROUND DATA

Economic value is an increasingly important component of health care policy decision making.

METHODS

Control patients: undergone ACDF (5 yr follow-up)

Direct costs: using the 2012 Medicare Fee schedule.

Health utility: Short Form-6D. (SF-36에서 몇 가지 항목을 발췌하여 수정한 설문지.)

RESULTS

▶Subject number: 352 patients (182 women+170 men)

▶Mean age: 44.6 yrs (22-73 yr)

▶Cost per patient(ACDF): $15,714

-41 repeat ACDFs, 15 posterior fusions, 6 foraminotomies, 2 implant removals, 2 hematoma evacuations, and 1 esophageal fistula repair were performed

▶Mean QALY:

-1yr fu: 0.16

-2yr fu: 0.18

-3yr fu: 0.17

-4yr fu: 0.18

-5yr fu: 0.18

-cumulative QALY over 5 yrs: 0.88

▶resultant cost/QALY

-1yr: $104,831

-2yr: $53,074

-3yr: $37,717

-4yr: $28,383

-5yr: $23,460

In this cohort, 11 nerve releases and 26 rotator cuff repairs were done within 5 years after the index ACDF.

CONCLUSION

Increasing health care costs call for demonstration of cost-effectiveness in order to justify payment for interventions, including ACDFs.

This study indicates that at 5-year follow-up, single-level instrumented ACDF is both effective and durable resulting in a favorable cost/QALY gained as compared to other widely accepted health care interventions.