Researchers assessed the cost effectiveness of anterior cervical discectomy and fusion (ACDF) versus cervical disc arthroplasty (CDA). Their findings: both methods are acceptable, but CDA is a bit less expensive overall.
CDA Slightly Less Expensive Than ACDF
1 min read Premium comments
#cervicaldiscarthroplastySecondary#spinefusion#acdf#cda
Samuel K. Cho, M.D. is associate professor of Orthopaedics at the Icahn School of Medicine at Mount Sinai, Chief of Spine Surgery and co-author of, “The Seven Year Cost-Effectiveness Of Anterior Cervical Discectomy And Fusion Versus Cervical Disc Arthroplasty.”
Dr. Cho presented the findings at the annual meeting of the American Academy of Orthopaedic Surgeons (AAOS) and told OTW, “This is an ongoing follow up of IDE [investigational device exemption] trial patients. Typically, the FDA requires a two year follow up. Obviously, there is tremendous value in following patients longer. There is a five-year study; this is an interim study before the 10-year data and subsequent analysis become available.”
“I had observed that CDA patients did as well as ACDF patients but continued to observe some complications from both cohorts. This study provides some perspective on the cost effectiveness of both procedures in a more objective manner.”
The authors wrote, “A Markov-state transition model was used to evaluate data from the MobiC [sic] IDE study. Data from the 12-item Short Form Health Survey were converted into utilities using the SF-6D algorithm for 179 CDA patients and 81 ACDF patients.”
“Costs were calculated from the payer perspective using 2017 Medicare reimbursement for diagnosis related groups (DRG) and current procedural terminology (CPT) codes…Quality adjusted life years (QALYs) were used to represent effectiveness. For the base case analysis, incremental cost effectiveness ratios (ICERs) were used to compare treatments. A willingness-to-pay threshold of $50,000/QALY was used…”
Dr. Cho commented to OTW, “Both ACDF and CDA provide cost effective solutions for patients suffering from cervical disc issues. CDA seems to be slightly more cost effective. We still need to follow these patients longer to see whether our results hold to be true long term. CDA patients may have fewer reoperations but we need longer follow up data to make it more conclusive.”
React:
Discussion
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.
Join the conversation
Orthopedic professionals are discussing this. Sign in and upgrade to read every comment and add your voice.