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.