Table 4: Cost-effectiveness of cervical surgery.

Authors Study design     No. Patients/Age (y) Procedures Follow Up  Outcomes  
Carreon, et al.  [60]                  Longitudinal cohort   N = 352ACDF Mean-44.6(Single level)   5 years -1 year- $104,831/QALY -2 years- $53,074/QALY -3 years- $37,717/QALY -4 years- $28,383/QALY -5 years- $23,460/QALY -0.88 QALY gain over 5 years                                  
Witiw, et al.                 [61]                            Prospective  observational cohort       N = 171  Mean-58.2          Anterior-only, posterior-only, or combined months 6, 12, 24 -0.139 mean QALY gain over 24 months -Estimated lifetime ICUR for surgical intervention is between $1,496.02/QALY to                                                                  $20,547.84/QALY      
Whitmore, et al.                  [62]                                                                                                                                                                Retrospective cohort Mean (dorsal)-63.9                                                                                                       N = 72  Mean (ventral)-60.5                                Ventral, or dorsal 1 year -0.16 QALY gain in 1 year with ventral surgery -0.13 QALY gain in 1 year with dorsal surgery   CCR Method: -Ventral direct costs- $21,563 -Dorsal direct costs- $27,942 (P = 0.02)   MRM Method: -Ventral direct costs-$17,538 -Dorsal direct costs-$16,579 (P = 0.29)  
Fehlings, et al.              [63]    Prospective  multicenter or combined             N = 70     Mean-55.25      Anterior-only, posterior-only 1 year -0.64 QALY gain over 10 years -Mean direct costs-$21,066 -$32,916/QALY gain      
Ghogawala, et al.                            [64] Prospective  pilot study          N = 50 ventral, or Mean-61.6 dorsal    1 year    -Ventral mean costs- $19,245   -Dorsal mean costs- $29,465      

Y: Years; ACDF: Anterior cervical discectomy and fusion; QALY: Quality-adjusted life year; ICUR: Incremental cost-to-utility ratio; CCR: Cost-to-charge ratio; MRM: Medicare reimbursement method.