Cost-utility analysis modeling at 2-year follow-up for cervical disc arthroplasty versus anterior cervical discectomy and fusion: A single-center contribution to the randomized controlled trial

Abstract

BackgroundPatients with cervical disc herniations resulting in radiculopathy or myelopathy from single level disease have traditionally been treated with Anterior Cervical Discectomy and Fusion (ACDF), yet Cervical Disc Arthroplasty (CDA) is a new alternative. Expert suggestion of reduced adjacent segment degeneration is a promising future result of CDA. A cost-utility analysis of these procedures with long-term follow-up has not been previously reported.MethodsWe reviewed single institution prospective data from a randomized trial comparing single-level ACDF and CDA in cervical disc disease. Both Medicare reimbursement schedules and actual hospital cost data for peri-operative care were separately reviewed and analyzed to estimate the cost of treatment of each patient. QALYs were calculated at 1 and 2 years based on NDI and SF-36 outcome scores, and incremental cost effectiveness ratio (ICER) analysis was performed to determine relative cost-effectiveness.ResultsPatients of both groups showed improvement in NDI and SF-36 outcome scores. Medicare reimbursement rates to the hospital were $11,747 and $10,015 for ACDF and CDA, respectively; these figures rose to $16,162 and $13,171 when including physician and anesthesiologist reimbursement. The estimated actual cost to the hospital of ACDF averaged $16,108, while CDA averaged $16,004 (p = 0.97); when including estimated physicians fees, total hospital costs came to $19,811 and $18,440, respectively. The cost/QALY analyses therefore varied widely with these discrepancies in cost values. The ICERs of ACDF vs CDA with Medicare reimbursements were $18,593 (NDI) and $19,940 (SF-36), while ICERs based on actual total hospital cost were $13,710 (NDI) and $9,140 (SF-36).ConclusionsWe confirm the efficacy of ACDF and CDA in the treatment of cervical disc disease, as our results suggest similar clinical outcomes at one and two year follow-up. The ICER suggests that the non-significant added benefit via ACDF comes at a reasonable cost, whether we use actual hospital costs or Medicare reimbursement values, though the actual ICER values vary widely depending upon the CUA modality used. Long term follow-up may illustrate a different profile for CDA due to reduced cost and greater long-term utility scores. It is crucial to note that financial modeling plays an important role in how economic treatment dominance is portrayed.

Long-Term Clinical Experience with Selectively Constrained SECURE-C Cervical Artificial Disc for 1-Level Cervical Disc Disease: Results from Seven-Year Follow-Up of a Prospective, Randomized, Controlled Investigational Device Exemption Clinical Trial

“…Contemporary studies have suggested that total disc arthroplasty can be cost-effective, primarily by decreasing the rate of secondary surgeries. [21][22][23][24][25] In this study, device-and surgery-related adverse events were lower in the SECURE-C group than in the ACDF group. In addition, the rate of secondary surgery at the treated index level was lower in the SECURE-C group than fusion, supporting trends reported in other studies comparing arthroplasty to ACDF.…”

Prospective, Randomized Comparison of One-level Mobi-C Cervical Total Disc Replacement vs. Anterior Cervical Discectomy and Fusion: Results at 5-year Follow-up

“…Several studies have compared the cost of single-level cervical TDR to ACDF. [33][34][35][36][37] Most of the studies found lower costs associated with TDR. A large-scale cost analysis of single-level TDR vs. ACDF has been conducted based on data collected from a Blue Health claims database.…”

“…Outcomes were evaluated preoperatively and at 6 weeks, 3,6,12,18,24,36,48 and 60 months postoperatively. The success endpoint used in this analysis was defined with the approval of the FDA within the Post Approval Study (PAS) protocol.…”

Seven-year cost-effectiveness of ProDisc-C total disc replacement: results from investigational device exemption and post-approval studies

“…36 Warren and colleagues used single-center data from 31 patients enrolled in the ProDisc-C IDE and found ACDF to be more costly but more effective than CTDR at 2 years. 43 Finally, Radcliff et al conducted a cost-minimization analysis comparing CTDR to ACDF and observed lower per member per month costs and reoperation rates through 36 months for CDTR patients. 37 This study of "real-world" data revealed that Blue Cross and Blue Shield plans incurred 12% lower costs for CTDR relative to ACDF due to lower readmission rates, fewer mechanical complications, lower index-surgery costs, and lower reoperation rates.…”