Is Surgery for Degenerative Cervical Myelopathy Cost Effective?

“Investments in surgical care will reduce overall health care expenditures for patients with DCM,” stated Michael G. Fehlings, MD.

While surgical treatment for degenerative cervical myelopathy (DCM) is costly, new findings suggest that surgical repair is associated with significant improvements in quality of life and is cost effective, according to a prospective observational study published online ahead of print in The Spine Journal.
Man using a calculator with a stethoscope in the foreground“Degenerative cervical myelopathy is the commonest cause of spinal cord impairment worldwide,” explained senior author Michael G. Fehlings, MD, PhD, who is Professor of Neurosurgery and Co-Director of the Spine Program at the University of Toronto in Ontario. “Surgical intervention for DCM is effective in halting the progression of this disorder and in promoting significant functional gains.”

"Previous efficacy data together with the cost efficacy and quality of life gains found in the present trial may help guide clinical decision making as well as policy decisions regarding healthcare resource allocations regarding treatment of DCM," Dr. Fehlings said.

Prospective Observational Study
The study involved all patients (N=171) undergoing surgery for DCM at a single center between 2005 and 2011. In the 2 years post-surgery, the mean quality adjusted life year (QALY) gains surgery was 0.139 (P<0.001) and the mean cost of treatment was $19,217.82. The cost of surgery comprised more than half of the total treatment cost (65.7%). Three patients required reoperation in the 2-year follow-up period.

Cost Efficacy Findings
The estimated lifetime incremental cost utility ratio (ICUR) for DCM was $20,547.84/QALY gained, with nearly all of the estimates (94.7%) categorized as “very cost effective” as defined by the World Health Organization. The estimated lifetime ICUR remained “very cost effective” for 97.9% of patients using a more general model structure ($11,496.02/QALY).

Clinical Implications
“Surgery is the recommended course of management for patients with DCM, and is safe and clinically effective,” Dr. Fehlings told SpineUniverse. “Surgical intervention should ideally be done when the neurological deficits are mild, and the duration of symptoms is relatively short—this achieves the optimal outcomes. However, surgery is an effective form of treatment for patients presenting with the full spectrum of neurological impairment (ranging from mild to moderate to severe).”

Dr. Fehlings emphasized the importance of patients and physicians awareness of the cardinal symptoms of DCM, especially given that the incidence and prevalence of DCM is expected to rise. These symptoms include “gait instability, hand numbness, and/or loss of dexterity as well as neck and arm pain. DCM is the most significant complication of arthritis, and greater societal and professional awareness is important.”

In addition, the findings can be used to guide policy decisions regarding healthcare resource allocations in that the findings indicate that surgery for DCM is highly cost-effective and results in reduced neurological and functional impairment. “Investments in surgical care will reduce overall health care expenditures for patients with DCM,” Dr. Fehlings concluded.

Updated on: 10/26/17
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