Cost-Effectiveness of Single-Level Anterior Cervical Discectomy and Fusion Five Years After Surgery

Study Design. Longitudinal cohort. Objective. The purpose of this study is 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 who had undergone ACDF with complete 5-year follow-up data who were part of the Investigational Device Exemption trials for cervical disc arthroplasty were identified. Direct costs for each intervention reported as part of the trial were determined using the 2012 Medicare Fee schedule. Health utility was determined using the Short Form-6D, calculated by transformation from the Short Form-36. Results. There were 352 patients (182 women, 170 men), mean age was 44.6 years (22-73 yr). Cost per patient for the index ACDF was $15,714. Over 5 years, 41 repeat ACDFs, 15 posterior fusions, 6 foraminotomies, 2 implant removals, 2 hematoma evacuations, and 1 esophageal fistula repair were performed. Mean QALY gained in each year of follow-up was 0.16, 0.18, 0.17, 0.18, and 0.18 for a cumulative 0.88 QALY gain over 5 years. The resultant cost/QALY gain at 1 year was $104,831; $53,074 at year 2; $37,717 at year 3; $28,383 at year 4; and $23,460 at year 5. In this cohort, 11 nerve releases and 26 rotator cuff repairs were done within 5 years after the index ACDF. Subanalysis to include upper extremity procedures was performed. The cost/QALY gained at 1 year including upper extremity procedures was $106,256; $54,622 at year 2; $38,836 at year 3; $29,454 at year 4; and $24,479 at year 5. 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.