The five-year cost-effectiveness of two-level anterior cervical discectomy and fusion or cervical disc replacement: a markov analysis

Publication date: Available online 30 June 2017
Source:The Spine Journal
Author(s): Samuel C. Overley, Steven J. McAnany, Robert L. Brochin, Jun S. Kim, Robert K. Merrill, Sheeraz A. Qureshi
Background ContextAnterior cervical discectomy and fusion (ACDF) and cervical disc replacement (CDR) are both acceptable surgical options for the treatment of cervical myelopathy and/or radiculopathy. To date, there are limited economic analyses assessing the relative cost-effectiveness of two-level ACDF versus CDR.PurposeThe purpose of this study was to determine the five-year cost-effectiveness of two-level ACDF versus CDR.Study DesignSecondary analysis of prospectively collected data.Patient SamplePatients in the Prestige Cervical Disc Investigational Device Exemption study who underwent either 2 level CDR or 2 level ACDF.Outcome MeasuresCost and quality adjusted life years (QALYs).MethodsA Markov-state transition model was used to evaluate data from the two-level Prestige Cervical Disc IDE study. Data from the 36-item Short Form Health Survey were converted into utilities using the SF-6D algorithm. Costs were calculated from the payer perspective. QALYs were used to represent effectiveness. A probabilistic sensitivity analysis was performed using a Monte Carlo simulation.ResultsThe base case analysis, assuming a 40 year-old person who failed appropriate conservative care, generated a five-year cost of $130,417 for CDR and $116,717 for ACDF. CDR and ACDF generated of 3.45 and 3.23 QALY's respectively. The ICER was calculated to be $62,337/QALY for CDR. The Monte Carlo simulation validated the base case scenario. CDR had an average cost of $130,445 (CI: $108,395; $152,761) with an average effectiveness of 3.46 (CI: 3.05; 3.83). ACDF had an average cost of $116,595 (CI: 95,439; $137,937) and an average effectiveness of 3.23 (CI: 2.84; 3.59). The ICER was calculated at $62,133/QALY with respect to CDR. Using a $100,000/QALY WTP, CDR is the more cost-effective strategy and would be selected 61.5% of the time by the simulation.ConclusionsTwo-level CDR and ACDF are both cost-effective strategies at five years. Neither strategy was found to be more cost-effective with an ICER greater than the $50,000/QALY WTP threshold. The assumptions used in the analysis were strongly validated with the results of the probabilistic sensitivity analysis.



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