A study published in the Journal of Neurosurgery: Spine examines the cost-effectiveness of cervical disc replacement compared with anterior cervical discectomy and fusion.
The article, published in November 2013, is a literature review to identify possible outcomes and their likelihood following CDR and ACDF. The authors created a surgical decision model for treating single-level cervical disc disease associated with radiculopathy. The quality-adjusted life years were measured in addition to the hospitalization costs.
Here are five findings from the study, with the model assuming 20-year duration for the CDR prosthesis:
1. Cervical disc replacement led to higher QALYs gained on average if both CDR and ACDF lasted 20 years. However, the study authors concluded both CDR and ACDF were cost-effective procedures in the cases referenced. For patients in a study of LDR's Mobi-C artificial for one-level procedures, success rate over 48 months was 69.5 percent, compared with 58.7 percent among ACDF patients.
The Mobi-C also showed superiority over ACDF at 12 months and 36 months for the primary study endpoint.
2. Cervical disc replacement also had a lower cost to society than spinal fusion. The cost per QALY for disc replacement was $3,042 which is significantly lower than $8,760 for ACDF. Savings could be even higher if the procedure is performed in an ambulatory surgery center. A 2011 study shows cervical disc replacement is a safe and effective procedure in the ASC setting, with disc replacement 62 percent less costly than ACDF and 84 percent less costly than if the disc replacement were performed in the inpatient setting.
3. The cervical disc replacement would need to survive at least 9.75 years to be considered more cost-effective than fusion. However, studies have also shown patients are less likely to develop adjacent segment disease with some cervical discs, potentially boosting clinical quality and lowering overall costs.
4. Eleven years after surgery the cervical disc replacement becomes an acceptable societal strategy, according to the study. At that time, the $50,000/QALY gained willingness-to-pay threshold is crossed. In a separate study comparing Mobi-C artificial discs to fusion, researchers found self-reported outcomes had significant improvement for artificial discs than fusion in these areas:
• Personal care
• Work
• Headaches/recreational headaches
• Reading
• Lifting
5. A sensitivity analysis showed disc replacement needed to provide at least 0.796 utility state to become cost-effective. The sensitivity analysis shows CDR must remain functional for at least 14 years to establish a greater cost-effectiveness than ACDF. "Since the current literature has yet to demonstrate with certainty the actual durability and long-term functionality of CDR, future long-term studies are required to validate the present analysis," concluded the study authors.
However, there is five year data on the ProDisc-C studied at 13 different treatment sites showing a 97.1 percent probability of no secondary procedures, compared with 85.5 percent for ACDF patients. None of the disc replacement patients had reoperations due to implant breakage or failure, and only 2.9 percent of the TDR patients had reoperations within five years of the initial surgery; 14.5 percent of the ACDF patients had reoperations within that time frame.
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