Cervical Disc Arthroplasty Found More Cost-Effective Than Anterior Cervical Discectomy for Disc Herniation

American Academy of Orthopaedic Surgeons (AAOS) 2018 Meeting Highlight with Samuel Cho, MD

While both cervical disc replacement (CDR) and single-level anterior cervical discectomy and fusion (ACDF) are cost-effective in the treatment of acute disc herniation, CDR appears to be more cost-effective than ACDF, according to findings from a 7-year study presented at the American Academy of Orthopaedic Surgeons 2018 Annual Meeting held March 6-10 in New Orleans, Louisiana.

Cervical instrumentation and fusionCervical instrumentation and fusion, such as ACDF may not be as cost-effective as total disc replacement. Photo Source: Shutterstock.
“Patients can expect to have equivalent outcomes whether they choose the traditional fusion or newer artificial disc replacement,” said senior author Samuel Cho, MD, Associate Professor of Orthopaedics at the Icahn School of Medicine at Mount Sinai, New York, NY. “The artificial disc costs slightly less than the fusion at 7 years with less risk of revision surgery.”

“The spine surgeon can choose either [procedure] for patients who qualify to benefit from surgery,” Dr. Cho told SpineUniverse. “One thing to keep in mind is that the criteria to qualify for the artificial disc replacement is more stringent than those for fusion. In other words, if there is a significant amount of spondylosis already present, fusion is the right choice. Therefore, these two procedures are not always interchangeable.”

Study Background and Design

CDR and ACDF have demonstrated equivalent effectiveness in large randomized investigational device exemption (IDE) studies, according to the study background. Short-term studies suggest that CDR may be more cost-effective than ACDF. The current study was designed to compare the long-term cost effectiveness of these surgical options for disc herniation.

A Markov-state transition model was used to evaluate data from a Mobi-C IDE study, which involved 179 patients who received CDR and 81 patients who received ACDF. Costs were calculated from the payer perspective using 2017 Medicare reimbursement for diagnosis related groups and current procedural terminology codes.

For the base case analysis, incremental cost effectiveness ratios (ICERs) were used to compare treatments in an ideal operative candidate who is 40-years-old and has failed conservative care for disc herniation. The willingness-to-pay (WTP) threshold was $50,000/quality adjusted life years (QALY), and a probabilistic sensitivity analysis was performed using a Monte Carlo simulation of 10,000 cycles to validate the input variables in the model.

Both ACDF and CDR Are Cost-Effective

As shown in the Table, 7-year costs were similar for the two procedures, and both were considered cost-effective. The ICER was calculated at $8,111/QALY in favor of CDR, which was less than the $50,000/QALY WTP threshold. The findings were validated in the probabilistic sensitivity analysis, which indicated that CDR would be chosen 54% of the time based on 10,000 simulations.

Seven-Year Cost-Effectiveness of ACDF and CDR in the Treatment of Disc HerniationSeven-Year Cost-Effectiveness of ACDF and CDR in the Treatment of Disc Herniation

Future Research Is Needed

“Up to 7 years, clinical outcomes and cost seem to be equal with slight preference toward the newer technology,” Dr. Cho told SpineUniverse. “However, we need to continue to follow these patients long-term (ie, over 10 years) to ensure our findings withstand the test of time.”

Dr. Cho is a paid consultant for Globus Medical and Medtronic, and is a paid consultant and has received research support from Zimmer. He is also a board or committee member of the AAOS, American Orthopaedic Association, AOSpine North America, Cervical Spine Research Society, North American Spine Society, and Scoliosis Research Society.

Updated on: 03/15/19
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