Anterior Cervical Discectomy and Fusion Versus Microendoscopic Posterior Cervical Foraminotomy for Unilateral Cervical Radiculopathy: A 1-Year Cost-Utility Analysis

被引:6
作者
Monk, Steve H. [1 ,2 ,3 ]
Hani, Ummey [1 ,2 ]
Pfortmiller, Deborah [1 ,2 ]
Dyer, E. Hunter [1 ,2 ]
Smith, Mark D. [1 ,2 ]
Kim, Paul K. [1 ,2 ]
Bohl, Michael A. [1 ,2 ]
Coric, Domagoj [1 ,2 ]
Adamson, Tim E. [1 ,2 ]
Holland, Christopher M. [1 ,2 ]
McGirt, Matthew J. [1 ,2 ]
机构
[1] Carolina Neurosurg & Spine Assoc, Charlotte, NC 28204 USA
[2] Atrium Hlth, SpineFirst, Charlotte, NC USA
[3] 225 Baldwin Ave, Charlotte, NC 28204 USA
关键词
Ambulatory surgery center; Anterior cervical discectomy and fusion; Cost utility; Microendoscopic; Posterior cervical foraminotomy; ADJUSTED LIFE-YEAR; QUALITY; MANAGEMENT; INSURERS; MEDICARE; SURGERY;
D O I
10.1227/neu.0000000000002464
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
BACKGROUND: Anterior cervical discectomy and fusion (ACDF) and posterior cervical foraminotomy (PCF) are the most common surgical approaches for medically refractory cervical radiculopathy. Rigorous cost-effectiveness studies comparing ACDF and PCF are lacking. OBJECTIVE: To assess the cost-utility of ACDF vs PCF performed in the ambulatory surgery center setting for Medicare and privately insured patients at 1-year follow-up. METHODS: A total of 323 patients who underwent 1-level ACDF (201) or PCF (122) at a single ambulatory surgery center were compared. Propensity matching generated 110 pairs (220 patients) for analysis. Demographic data, resource utilization, patient-reported outcome measures, and quality-adjusted life-years were assessed. Direct costs (1-year resource use x unit costs based on Medicare national allowable payment amounts) and indirect costs (missed workdays x average US daily wage) were recorded. Incremental cost-effectiveness ratios were calculated. RESULTS: Perioperative safety, 90-day readmission, and 1-year reoperation rates were similar between groups. Both groups experienced significant improvements in all patient-reported outcome measures at 3 months that was maintained at 12 months. The ACDF cohort had a significantly higher preoperative Neck Disability Index and a significantly greater improvement in health-state utility (ie, quality-adjusted life-years gained) at 12 months. ACDF was associated with significantly higher total costs at 1 year for both Medicare ($11 744) and privately insured ($21 228) patients. The incremental cost-effectiveness ratio for ACDF was $184 654 and $333 774 for Medicare and privately insured patients, respectively, reflecting poor cost-utility. CONCLUSION: Single-level ACDF may not be cost-effective in comparison with PCF for surgical management of unilateral cervical radiculopathy.
引用
收藏
页码:628 / 635
页数:8
相关论文
共 46 条
[1]   Microendoscopic posterior cervical laminoforaminotomy for unilateral radiculopathy: results of a new technique in 100 cases [J].
Adamson, TE .
JOURNAL OF NEUROSURGERY, 2001, 95 (01) :51-57
[2]   Anterior cervical discectomy and fusion in the outpatient ambulatory surgery setting compared with the inpatient hospital setting: analysis of 1000 consecutive cases [J].
Adamson, Tim ;
Godil, Saniya S. ;
Mehrlich, Melissa ;
Mendenhall, Stephen ;
Asher, Anthony L. ;
McGirt, Matthew J. .
JOURNAL OF NEUROSURGERY-SPINE, 2016, 24 (06) :878-884
[3]   Ninety-Day Bundled Payment Reimbursement for Patients Undergoing Anterior and Posterior Procedures for Degenerative Cervical Radiculopathy [J].
Alhourani, Ahmad ;
Sharma, Mayur ;
Ugiliweneza, Beatrice ;
Wang, Dengzhi ;
Nuno, Miriam ;
Drazin, Doniel ;
Boakye, Maxwell .
NEUROSURGERY, 2019, 85 (05) :E851-E858
[4]   Cost-Utility Analysis of Anterior Cervical Discectomy and Fusion With Plating (ACDFP) Versus Posterior Cervical Foraminotomy (PCF) for Patients With Single-level Cervical Radiculopathy at 1-Year Follow-up [J].
Alvin, Matthew D. ;
Lubelski, Daniel ;
Abdullah, Kalil G. ;
Whitmore, Robert G. ;
Benzel, Edward C. ;
Mroz, Thomas E. .
CLINICAL SPINE SURGERY, 2016, 29 (02) :E67-E72
[5]  
American Hospital Association, 2018, TRENDW CHARTB 2018 T
[6]  
[Anonymous], 2022, REAL AV HOURL EARN A
[7]  
[Anonymous], CAP REAL GROSS DOM P
[8]   Market Power: Price Variation Among Commercial Insurers For Hospital Services [J].
Bai, Ge ;
Anderson, Gerard F. .
HEALTH AFFAIRS, 2018, 37 (10) :1615-1622
[9]   Physician Practice Competition and Prices Paid by Private Insurers for Office Visits [J].
Baker, Laurence C. ;
Bundorf, M. Kate ;
Royalty, Anne B. ;
Levin, Zachary .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2014, 312 (16) :1653-1662
[10]   What does the value of modern medicine say about the $50,000 per Quality-Adjusted Life-Year decision rule? [J].
Braithwaite, R. Scott ;
Meltzer, David O. ;
King, Joseph T., Jr. ;
Leslie, Douglas ;
Roberts, Mark S. .
MEDICAL CARE, 2008, 46 (04) :349-356