Long Term Societal Costs of Anterior Discectomy and Fusion (ACDF) versus Cervical Disc Arthroplasty (CDA) for Treatment of Cervical Radiculopathy

Ghori, Ahmer K.; Konopka, Joseph F.; Makanji, Heeren S.; Thomas, D.; Bono, Christopher M.

doi:10.14444/3001

Cited by 22 publications

(13 citation statements)

References 32 publications

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“…A study of 60 consecutive cervical radiculopathy patients found that CDR was associated with similar improvements in VAS-neck pain and Short-Form 12 questionnaire compared with ACDF, however cost-effectiveness was best with ACDF with cage alone [26]. Interestingly, one economic and decision analysis found that for radiculopathy patients, CDR resulted in lower long-term costs compared with ACDF [27]. Finally, a cohort study of CDR compared with posterior microendoscopic laminoforaminotomy for radiculopathy patients found no significant difference in improvements in NDI, VAS-neck pain, or VAS-arm pain at 3-, 6-, 12-, and 24-month follow-up [28].…”

Section: Discussionmentioning

confidence: 99%

Effect of Myelopathy on Early Clinical Improvement After Cervical Disc Replacement: A Study of a Local Patient Cohort and a Large National Cohort

et al. 2019

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Objective: Cervical disc replacement (CDR) is an effective long-term treatment for both cervical radiculopathy and myelopathy. However, there may be unique differences in the early postoperative clinical improvement for patients with and without myelopathy. In addition, previous studies using CDR to treat cervical myelopathy were underpowered to determine risk factors for relatively postoperative medical complications. Methods: Two different cohorts were studied. A local cohort of patients undergoing CDR by a single surgeon was utilized to study the early postoperative course of clinical improvement. In addition, a national cohort of patients undergoing CDR in the 2015 and 2016 National Surgical Quality Improvement Program database was utilized to study differences in postoperative medical complications after CDR. Patients with a preoperative diagnosis of cervical myelopathy were identified in both cohorts, and perioperative outcomes and complications were compared to patients without myelopathy. Results: A total of 43 patients undergoing CDR were included in the institutional cohort, of those 16 patients (37% of cohort) had a preoperative diagnosis of cervical myelopathy. A total of 3,023 patients undergoing CDR were included in the national cohort, of those 411 (13% of cohort) had a preoperative diagnosis of cervical myelopathy. In the institutional cohort, the nonmyelopathy group had a lower initial Neck Disability Index (NDI) and saw a faster improvement in NDI by 2 weeks postoperative. However, at 24 weeks there was no significant difference between groups in terms of NDI. Interestingly, only the nonmyelopathy cohort had a significant improvement in modified Japanese Orthopaedic Association score by 6 weeks (p < 0.05). In the national cohort, myelopathy was associated with longer operative time and length of stay (p < 0.05). However, there was no significant difference in perioperative complications (p > 0.05) between myelopathy and nonmyelopathy patients. Conclusion: Significant improvements in NDI, visual analogue scale (VAS)-arm pain, and VAS-neck pain are seen in both myelopathy and nonmyelopathy populations undergoing CDR by 6 weeks postoperatively. However, nonmyelopathy populations improve faster by 2 weeks postoperatively. In the national cohort analysis, medical complications were similarly low in both myelopathy and nonmyelopathy groups.

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Section: Discussionmentioning

confidence: 99%

Effect of Myelopathy on Early Clinical Improvement After Cervical Disc Replacement: A Study of a Local Patient Cohort and a Large National Cohort

et al. 2019

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“…Three prospective economic evaluations [48,58,66] were included; all others were retrospective CEAs or CUAs. In a total of 5 studies, a Markov Analysis was performed [44,45,47,51,56].…”

Section: Study Characteristicsmentioning

confidence: 99%

“…The six remaining studies described costs without (surgical) cohort [51,54,57] or compared auto-and allograft techniques for ACDF, but costs are represented separately [Table 1] [52, 53,55]. There was a large variety in the evaluated study populations, as some studies only included patients with radiculopathy [46,47,49,51,53] or myelopathy [48,66], and other studies specifically evaluated singlelevel surgeries [46,49,54,55,59,63,69,70] in contrast to those that only assessed multi-level surgeries [43,48,56,61,64].…”

Section: Study Characteristicsmentioning

confidence: 99%

Cost-effectiveness of anterior surgical decompression surgery for cervical degenerative disk disease: a systematic review of economic evaluations

et al. 2022

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Purpose No clear consensus exists on which anterior surgical technique is most cost-effective for treating cervical degenerative disk disease (CDDD). One of the most common treatment options is anterior cervical discectomy with fusion (ACDF). Anterior cervical discectomy with arthroplasty (ACDA) was developed in an effort to reduce the incidence of clinical adjacent segment pathology and associated additional surgeries by preserving motion. This systematic review aims to evaluate the evidence regarding the cost-effectiveness of anterior surgical decompression techniques used to treat radiculopathy and/or myelopathy caused by CDDD. Methods The search was conducted in PubMed, EMBASE, Web of Science, CINAHL, EconLit, NHS-EED and the Cochrane Library. Studies were included if healthcare costs and utility or effectivity measurements were mentioned. Results A total of 23 studies were included out of the 1327 identified studies. In 9 of the 13 studies directly comparing ACDA and ACDF, ACDA was the most cost-effective technique, with an incremental cost effectiveness ratio ranging from $2.900/QALY to $98.475/QALY. There was great heterogeneity between the costs of due to different in- and exclusion criteria of costs and charges, cost perspective, baseline characteristics, and calculation methods. The methodological quality of the included studies was moderate. Conclusion The majority of studies report ACDA to be a more cost-effective technique in comparison with ACDF. The lack of uniform literature impedes any solid conclusions to be drawn. There is a need for high-quality cost-effectiveness research and uniformity in the conduct, design and reporting of economic evaluations concerning the treatment of CDDD. Trial registration PROSPERO Registration: CRD42020207553 (04.10.2020).

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“…89 Although there are limited reports using indirect costs from a societal perspective, Ghori et al demonstrated that ACDF was more expensive in the long-term with costs of $31,780 compared to $24,119 for patients aged 45 to 65 years old, and taking into consideration loss of productivity and reoperation rates. 90,91 Ament et al also demonstrated that CDA was the leading intervention with an ICER of -$165,103 per QALY when considering indirect costs and using $50,000 as the threshold for WTP at 5 year follow-up. 84 These results suggest that CDA is more cost-effective when considering decreased productivity loss and increased return-to-work compared to ACDF.…”

Section: Comparison Of Cost-effectiveness Between Acdf and Cdamentioning

confidence: 99%

Financial Aspects of Cervical Disc Arthroplasty: A Narrative Review of Recent Literature

et al. 2020

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Long Term Societal Costs of Anterior Discectomy and Fusion (ACDF) versus Cervical Disc Arthroplasty (CDA) for Treatment of Cervical Radiculopathy

Cited by 22 publications

References 32 publications

Effect of Myelopathy on Early Clinical Improvement After Cervical Disc Replacement: A Study of a Local Patient Cohort and a Large National Cohort

Effect of Myelopathy on Early Clinical Improvement After Cervical Disc Replacement: A Study of a Local Patient Cohort and a Large National Cohort

Cost-effectiveness of anterior surgical decompression surgery for cervical degenerative disk disease: a systematic review of economic evaluations

Financial Aspects of Cervical Disc Arthroplasty: A Narrative Review of Recent Literature

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