Cost-effectiveness of anterior surgical decompression surgery for cervical degenerative disk disease: a systematic review of economic evaluations

Abstract

Purpose No clear consensus exists on which anterior surgical technique is most cost-effective for treating cervical degenerative disk disease (CDDD). One of the most common treatment options is anterior cervical discectomy with fusion (ACDF). Anterior cervical discectomy with arthroplasty (ACDA) was developed in an effort to reduce the incidence of clinical adjacent segment pathology and associated additional surgeries by preserving motion. This systematic review aims to evaluate the evidence regarding the cost-effectiveness of anterior surgical decompression techniques used to treat radiculopathy and/or myelopathy caused by CDDD. Methods The search was conducted in PubMed, EMBASE, Web of Science, CINAHL, EconLit, NHS-EED and the Cochrane Library. Studies were included if healthcare costs and utility or effectivity measurements were mentioned. Results A total of 23 studies were included out of the 1327 identified studies. In 9 of the 13 studies directly comparing ACDA and ACDF, ACDA was the most cost-effective technique, with an incremental cost effectiveness ratio ranging from $2.900/QALY to $98.475/QALY. There was great heterogeneity between the costs of due to different in- and exclusion criteria of costs and charges, cost perspective, baseline characteristics, and calculation methods. The methodological quality of the included studies was moderate. Conclusion The majority of studies report ACDA to be a more cost-effective technique in comparison with ACDF. The lack of uniform literature impedes any solid conclusions to be drawn. There is a need for high-quality cost-effectiveness research and uniformity in the conduct, design and reporting of economic evaluations concerning the treatment of CDDD. Trial registration PROSPERO Registration: CRD42020207553 (04.10.2020).

Anterior Cervical Discectomy and Fusion in the Ambulatory Surgery Center Versus Inpatient Setting: One-Year Cost-Utility Analysis

“…cervical disk replacement or posterior cervical fusion). 18 Only two studies by Martin et al 19 and Safaee et al 20 have reported cost in the outpatient setting, but both specifically excluded the ambulatory setting. This report thus represents the first and only cost-effectiveness Figure 1.…”

“…Most cost-effectiveness studies in the literature compare ACDF to other cervical procedures (e.g. cervical disk replacement or posterior cervical fusion) 18. Only two studies by Martin et al 19 and Safaee et al 20 have reported cost in the outpatient setting, but both specifically excluded the ambulatory setting.…”

RESEARCH PROTOCOL: Cervical Arthroplasty Cost Effectiveness Study (CACES) Economic Evaluation of Anterior Cervical Discectomy With Arthroplasty Versus Anterior Cervical Discectomy With Fusion in the Surgical Treatment of Cervical Degenerative Disc Disease, a Randomized Controlled Trial.

“…The primary outcome of the proposed study is cost-effectiveness. No difference in QALYs is expected between the intervention and control group based on previous literature 41 .…”

“…However, not all aspects have been su ciently investigated. Only few studies have investigated the cost-effectiveness between techniques, although not in such an extensive, prospective, randomized controlled trial 41,94 .…”

“…However, preventing new complaints and additional surgeries due to CASP might be a reason for ACDA to be a more cost-effective technique in the long-term. A systematic review of economic evaluations in anterior cervical decompression surgery was conducted by our research group 41 . Indeed, the majority of studies reported ACDA to be the most cost-effective technique despite the higher implant costs.…”