Single-level anterior cervical discectomy and fusion versus minimally invasive posterior cervical foraminotomy for patients with cervical radiculopathy: a cost analysis

Abstract

Object Patients suffering from cervical radiculopathy in whom a course of nonoperative treatment has failed are often candidates for a single-level anterior cervical discectomy and fusion (ACDF) or posterior cervical foraminotomy (PCF). The objective of this analysis was to identify any significant cost differences between these surgical methods by comparing direct costs to the hospital. Furthermore, patient-specific characteristics were also considered for their effect on component costs. Methods After obtaining approval from the medical center institutional review board, the authors conducted a retrospective cross-sectional comparative cohort study, with a sample of 101 patients diagnosed with cervical radiculopathy and who underwent an initial single-level ACDF or minimally invasive PCF during a 3-year period. Using these data, bivariate analyses were conducted to determine significant differences in direct total procedure and component costs between surgical techniques. Factorial ANOVAs were also conducted to determine any relationship between patient sex and smoking status to the component costs per surgery. Results The mean total direct cost for an ACDF was $8192, and the mean total direct cost for a PCF was $4320. There were significant differences in the cost components for direct costs and operating room supply costs. It was found that there was no statistically significant difference in component costs with regard to patient sex or smoking status. Conclusions In the management of single-level cervical radiculopathy, the present analysis has revealed that the average cost of an ACDF is 89% more than a PCF. This increased cost is largely due to the cost of surgical implants. These results do not appear to be dependent on patient sex or smoking status. When combined with results from previous studies highlighting the comparable patient outcomes for either procedure, the authors' findings suggest that from a health care economics standpoint, physicians should consider a minimally invasive PCF in the treatment of cervical radiculopathy.

Comparison of Anterior Cervical Discectomy and Fusion versus Posterior Cervical Foraminotomy in the Treatment of Cervical Radiculopathy: A Systematic Review

“…); 1 trial protocol article and 1 expert opinion article were excluded. The remaining 10 studies were finally included, comprising 3 prospective randomized controlled trails (RCT) and 7 retrospective comparative studies (RCoS). Details of these studies are listed in Table .…”

“…Three RCoS reported cost or cost‐effectiveness of both groups in the treatment of single‐level cervical radiculopathy. Mansfield et al reported that the average cost of an ACDF was 89% more than a PCF with 3 years follow‐up time. Alvin et al reported that the cost‐utility ratio of PCF group was 39% lower than that of ACDF group with 1 year follow‐up time.…”

“…Three RCoS reported cost or cost‐effectiveness of both groups in the treatment of single‐level cervical radiculopathy. All these studies reported that the average cost or cost‐utility of PCF group was significantly lower than ACDF group.…”

“…First, the included studies are in English; thus, a potential language bias may exist in this systematic review. Second, the sample size may not be large enough to find possible existing evidence, especially the sample size of 2 RCT and 4 RCoS; larger‐scale studies are further needed to provide more reliable evidence for future evaluation. Third, there was a variable length of time in the follow‐ups between some of the studies and this complicated evaluating and comparing the surgical results.…”

Study protocol for a randomised controlled multicentre study: the Foraminotomy ACDF Cost-Effectiveness Trial (FACET) in patients with cervical radiculopathy

“…The explanation for this is most likely the high costs of implants used in ACDF. Mansfield et al 18 reported an average difference of $3872 between ACDF and FOR, with $3143 of this difference contributable to costs in the operating room (including materials). Tumialán et al 20 found a difference of $6508 between FOR and ACDF with plating.…”