Anterior cervical discectomy and fusion (ACDF) versus cervical disc replacement (CDR)…anyone know which is more cost-effective? Now we do.
Multiple Level Cervical Disc Replacement Cost Study
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#spineSecondary#fusion#cervicaldiscectomy
The study, “The 5-year cost-effectiveness of two-level anterior cervical discectomy and fusion or cervical disc replacement: a Markov analysis,” appears in the January 2018 edition of The Spine Journal. (http://www.thespinejournalonline.com/article/S1529-9430(17)30310-8/fulltext)
Sheeraz A. Qureshi, M.D., author of the study and an Associate Attending Orthopedic Surgeon at the Hospital for Special Surgery and an Associate Professor of Orthopedic Surgery at Weill Cornell Medical College in New York, told OTW, “Two-level cervical disc replacement is becoming increasingly performed in place of two-level anterior cervical discectomy and fusion. Any time a new procedure or technology is introduced to everyone I think it is important to understand the implications of cost and effectiveness.”
The authors wrote, “Patients in the Prestige cervical disc investigational device exemption (IDE) study who underwent either a two-level CDR or a two-level ACDF were included in the study.”
Dr. Qureshi told OTW, “We used data from the Medtronic IDE studies and had patient reported outcomes for both groups of patients out to five years. We found that both procedures are cost effective options for the treatment of cervical disc disease all the way out to five years.”
The authors wrote, “The base-case analysis, assuming a 40-year-old person who failed appropriate conservative care, generated a 5-year cost of $130,417 for CDR and $116,717 for ACDF. Cervical disc replacement and ACDF generated 3.45 and 3.23 QALYs [quality-adjusted life years], respectively. The incremental cost-effectiveness ratio (ICER) was calculated to be $62,337/QALY for CDR.”
Dr. Qureshi commented to OTW, “In appropriately indicated patients, spine surgeons can feel confident that cervical disc replacement at multiple levels is a cost effective option. The positive clinical impact of cervical disc replacement at one level is well accepted. At two levels, we feel that this impact will be even greater and knowing that the option is cost effective compared to anterior cervical discectomy and fusion can help us when we talk to patients, hospitals, and pastors.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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