There isn't much data available today on cost-effectiveness for treating cervical degenerative disc disease, despite the many patients who undergo treatment every year.
Cervical degenerative disc disease is a common cause of clinical syndromes, according to a study published in Spine, and the appropriate interventions are controversial. There isn't strong data to show which treatments can improve quality of life outcomes, reduce complications and limit costs for different types of patients.
Researchers conducted a systematic search in PubMed/MEDLINE, EMBASE, the Cochrane Collaboration Library, Cost-Effectiveness Analysis registry database and the National Health Service Economic Evaluation Database for economic evaluations published before Jan. 16, 2014.
There were five studies identified and included in the analysis. The researchers found:
1. Two studies showed cervical disc replacement might be more cost-effective than anterior cervical discectomy and fusion.
2. Two studies comparing anterior and posterior surgical procedures for cervical spondylotic myelopathy show anterior surgery was more cost-effective.
3. Posterior cervical foraminotomy had a greater net economic benefit than anterior cervical discectomy and fusion, according to one study of the military population with unilateral cervical radiculopathy.
4. Existing studies demonstrate surgical intervention cost-effectiveness for two clinical entities.
5. To date, no studies assess whether nonoperative treatment for cervical myelopathy or radiculopathy is more or less cost-effective than surgical intervention.
"Future research is necessary to validate the findings of the few studies that do exist to guide decisions for surgery by the physician and patient with respect to cost-effectiveness," concluded the study authors. There are several ongoing initiatives to bridge the gap in the literature comparing outcomes and cost between operative and nonoperative treatment, but researchers also face challenges.
It can be difficult for surgeons to randomize patients into operative or nonoperative groups, especially if they feel one treatment would be more successful than another for a particular patient. Patient variables also have a huge impact on outcomes and overall cost of care. But, with registry efforts and electronic information gathering, surgeons can track large amounts of data better than ever.